Pursuant to clause 2(e)(4) of Rule XI of the Rules of the House,
public hearing records of the Committee on Veterans' Affairs are also
published in electronic form. The printed hearing record remains
the official version. Because electronic submissions are used
to prepare both printed and electronic versions of the hearing record,
the process of converting between various electronic formats may
introduce unintentional errors or omissions. Such occurrences are
inherent in the current publication process and should diminish as the
process is further refined.

This hearing represents an important step in the legislative process; and, as
such, I look forward to a frank and productive conversation about the policy
implications, merits, and potential unintended consequences of each of the
proposals on our agenda today.

One of the bills we will discuss this afternoon is H.R. 2074, the "Veterans
Sexual Assault Prevention Act," a bill I introduced in response to a truly
alarming report issued last month by the U.S. Government Accountability Office
(GAO) on the prevalence of sexual assault and other safety instances in VA
facilities. I am pleased to sponsor this legislation with our Chairman, Jeff
Miller, and with Ranking Members Bob Filner and Mike Michaud as co-sponsors.

In their report, the GAO found that between January of 2007 and July of 2010,
nearly 300 sexual assaults, including 67 alleged rapes, were reported to the VA
police. Troubling and in direct violation of Federal regulations and VA policy,
many of these incidents were not properly reported to VA leadership officials or
the VA Office of the Inspector General (OIG).

As disturbing, GAO uncovered serious deficiencies in the guidance and
oversight provided by VA leadership officials on the reporting, the management,
and the tracking of sexual assault and other safety incidents.

GAO also found that the Department failed to accurately assess risk or take
effective precautionary measures, with inadequate monitoring of surveillance
systems and malfunctioning or failing panic alarms.

As someone who has been a domestic violence legal counselor, I have seen
firsthand the pervasive and damaging effects of sexual assault and the effect it
can have on the lives of those who experience it. Abusive behavior, like
the kind documented by GAO, is unacceptable in any form. But for it to be found
in what should be an environment of caring for our honored veterans is simply
intolerable and unacceptable.

H.R. 2074 would address the safety vulnerabilities, security problems, and
oversight failures identified by GAO and create a fundamentally safer
environment for veteran patients and VA employees. Specifically, H.R. 2074 would
require VA to develop clear and comprehensive criteria with respect to the
reporting of sexual assaults and other safety incidents for both clinical and
law enforcement personnel.

It would establish a newly accountable oversight system within the Veterans
Health Administration (VHA), to include a centralized and comprehensive policy
on the reporting and tracking of sexual assaults covering all alleged or
suspected forms of abusive or unsafe acts, as well as the systematic monitoring
of reported instances to ensure each case is fully investigated and victims
receive the appropriate care.

To correct serious weaknesses observed in the physical security of VA medical
facilities and to improve the Department's ability to appropriately assess risk
and take the proper preventative steps, H.R. 2074 would mandate the Department
to develop risk-assessment tools, create a mandatory safety awareness and
preparedness training program for employees, as well as to establish physical
security precautions, including appropriate surveillance and panic alarm systems
that are operable and regularly tested.

It is critical and very important that we take every available step to
protect the personal safety and well-being of the veterans who seek care through
our VA system and all of the hardworking employees who strive to provide that
care on a daily basis. I am eager to discuss H.R. 2074 this afternoon, and I am
here to answer any questions that my colleagues might have regarding this
legislation.

Also on our agenda today is a draft Committee proposal, the "Veterans Health
Care Capital Facilities Improvement Act of 2011." This draft legislation
incorporates the Administration's fiscal year 2012 construction request to
authorize major medical facility projects and leases. The draft proposal
also modifies the statutory requirements for the Department to provide a
prospectus to Congress when seeking authorization for a major medical facility
project to ensure that Congress receives a comprehensive and accurate
cost-benefit analysis as the basis for making these critical decisions.

This bill also extends authorities to provide for important programs related
to such initiatives as housing assistance for homeless veterans and treatment
and rehab for veterans with serious mental illness, both of which are set to
expire at the end of this calendar year. Additionally, section 6 of the
draft bill seeks to provide an extension of the VA's enhanced use lease
authority, which is also set to expire this year.

This authority is an innovative and vitally important approach to supporting
goals we all share, such as reducing homelessness among our veteran population
and making effective use of vacant or underutilized VA property through
public-private partnerships. Unfortunately, the Congressional Budget
Office (CBO) has scored this provision with a mandatory spending cost of
$700 million. We want to work with the Department and the veterans service
organizations (VSOs) to resolve this scoring issue to ensure that the VA has the
authority to continue utilizing this extremely important program.

The draft bill also includes legislation that was brought to us by our
colleague from Colorado, Scott Tipton, to designate the Telehealth Clinic at
Craig, Colorado, as the Major William Edward Adams Department of Veteran Affairs
Clinic. Major William Edward Adams is a Medal of Honor recipient, and Scott has
provided a statement for the record detailing Major Adam's courageous service to
our country.

I want to thank all of the Members who sponsored bills and draft legislation
before us today, as well as the witnesses from the veteran service
organizations, as well as the VA, for taking time out of their busy schedules to
share their expertise with us this afternoon. I look forward to our discussion;
and I will now yield to the Ranking Member, Mr. Michaud, for any opening
statement he may have.

Mr. MICHAUD. Thank you very much, Madam Chair. I, too, would like to thank
everyone for coming today.

Today's legislative hearing is an opportunity for Members of Congress,
veterans, the VA, and other interested parties to provide their viewpoint and
discussion of legislation that is before the Subcommittee this afternoon. We
have seven bills, as you heard earlier, before us today, which address a number
of important issues to our veterans and provide the staff of the Department of
Veterans Affairs with the necessary tools to provide the best care for our
veterans.

First, we have two bills to help veterans' with post-deployment mental health
issues through training service dogs. The remainder of the legislation covers a
wide range of topics, such as improved traumatic brain injury (TBI) care, sexual
assault prevention, facility construction, and spina bifida.

We will also examine my bill, H.R. 2530, which seeks to increase the
flexibility in payments for State veterans homes. It would require State
veterans homes and the VA to enter into a contract for the purpose of providing
nursing home care to veterans who need such care for service-connected
conditions or have a service-connected rating of 70 percent or greater.

We have been dealing with this issue since 2006. It took 2 years for the VA
to implement the rules and regulations. Then it has taken a couple of years for
us to really get to the point where we are today, that we hopefully will be able
to move this legislation forward so we can deal with the reimbursement rate
issues for State veterans nursing homes before I get to an age where I might be
needing a State veterans nursing home. So, hopefully, we will be able to
get this dealt with this Congress.

We will now turn to our first panel here today. It is an honor to be able to
recognize such a distinguished group of my colleagues joining us this afternoon
to discuss the legislation that they have introduced.

First is Michael Grimm, a fellow New Yorker and a Marine Corps veteran. Thank
you for your service, and thank you for being here today. Next to Mr. Grimm is
Tim Walz, a 24-year veteran of the National Guard and a lifetime member—a
long-time, sorry, not lifetime—long-time Member of this Committee. And Dr. Larry
Bucshon, a Hoosier from the State of Indiana.

Welcome to all of you. Thank you for taking the time to be here today.

And, Mr. Grimm, we will start with you and your testimony.

STATEMENTS OF HON. MICHAEL G. GRIMM, A REPRESENTATIVE IN CONGRESS FROM THE
STATE OF NEW YORK; HON. TIMOTHY J. WALZ, A REPRESENTATIVE IN CONGRESS FROM THE
STATE OF MINNESOTA; AND HON. LARRY BUCSHON, A REPRESENTATIVE IN CONGRESS FROM
THE STATE OF INDIANA

STATEMENT OF HON. MICHAEL G. GRIMM

Mr. GRIMM. Madam Chair, thank you very much. It is always good to see a
fellow New Yorker.

Ranking Member Michaud and all the Members of the Committee, thank you so
much for allowing me the honor of testifying today on H.R. 198, the "Veterans
Dog Training Therapy Act."

As a Marine combat veteran, it is a unique honor for me to address this
Committee. Having seen firsthand both the physical and mental wounds of war that
the members of our Nation's military are faced with, I have a special
appreciation for the important work this Committee does every day.

Today, over two million Iraq and Afghanistan veterans have returned home to
the challenge of an unemployment rate hovering near 10 percent, which for
disabled veterans is actually closer to 20 percent. And, for many, the long road
to recovery from the mental and physical wounds sustained during their service,
sadly these numbers continue rising.

Over the last 6 months, I have had the honor to meet with a number of our
Nation's heroes who are now faced with the challenges of coping with PTSD and
physical disabilities resulting from their service in Iraq and Afghanistan. It
was these personal accounts of their recovery, both physical and mental, and the
important role therapy and service dogs played that inspired my role in this
legislation.

The "Veterans Dog Training Therapy Act" would require the Department of
Veterans Affairs to conduct a 5-year pilot program in at least three but not
more than five VA medical centers assessing the effectiveness and addressing
post-deployment mental health and post-traumatic stress disorder (PTSD)
throughout the therapeutic medium of training service dogs for veterans with
disabilities. These trained service dogs are then given to physically disabled
veterans to help them with their daily activities. Simply put, this program
treats veterans suffering from PTSD while at the same time aiding those
suffering from physical disabilities.

Since I introduced this legislation, it has gained the bipartisan support of
84 co-sponsors, including Financial Services Committee Chairman Spencer Bachus
and Ranking Member Barney Frank, as well as Congressman Pete Sessions and Steve
Israel. Clearly, this legislation has brought together a number of unlikely
allies in support of our Nation's veterans.

Additionally, with veteran suicide rates at an all-time high and more
servicemen and women being diagnosed with PTSD, this bill meets a crucial need
for additional treatment methods. I believe that by caring for our Nation's
veterans suffering from the hidden wounds of PTSD, while at the same time
providing assistance dogs to those with physical disabilities, we create a
win-win for everyone, which I believe is a goal we can all be proud of.

Working in conjunction with a number of veteran service organizations,
including AMVETS and VetsFirst, I have drafted updated language which I intend
to have submitted during Committee markup to ensure this program provides our
Nation's veterans with the highest quality of care for both PTSD and physical
disabilities while maintaining my commitment to fiscal responsibility.

I understand that in the current economic situation we are faced with
especially important decisions, decisions that must ensure that taxpayer dollars
are spent wisely, which is why I have identified several possibilities to offset
and to make sure that this legislation meets the PAYGO requirements. As we move
forward in the legislative process, I look forward to working with this
Committee to ensure that any money allocated for this program is offset by
reductions in other accounts.

Again, I would like to thank the Committee for holding today's hearing, and I
look forward to working with you to ensure that this program is included in your
continuing efforts to guarantee that our Nation's heroes have the best possible
programs for treating PTSD and providing disability assistance.

I would like to extend a special thank you to the Ranking Member for helping
me move this legislation along and, again, to everyone that works so hard every
day on this Committee to ensure our veterans have the very best that we have to
offer in Congress.

Mr. WALZ. Thank you, Madam Chairwoman and Ranking Member Michaud. It is a
privilege to be here in front of you. I know what each of you and Members of
this Committee give to the care of our veterans. You are truly the voice of a
grateful Nation to provide the care and benefits that our warriors so bravely
earned.

And I would also like to note the great landmark legislation that comes out
of this Committee. This Committee conducts itself in a manner that is the envy
of all of Congress in a bipartisan manner, with the sole focus on caring for our
veterans. So, Chairwoman, I congratulate you on keeping that great tradition
alive and am very appreciative to be here.

The piece of legislation I am introducing, H.R. 1855, the "Traumatic Brain
Injury Rehabilitative Services Improvement Act," was introduced last year along
with Chairman Miller and Congressman Bilirakis. I am very appreciative of
getting this opportunity to hear on this and hopefully moving it to markup.

As my colleague and another veteran so clearly indicated, an unprecedented
number of warriors are returning from our wars, having served proudly. Having
witnessed and been many occasions to the polytrauma center in Minneapolis, I
have seen the incredible battlefield care that is being given to these severely
wounded warriors.

But traumatic brain injuries as they come back are the most complex of these
injuries. Each case is unique. The injuries can result in a wide-ranging loss of
function. Neurological and cognitive loss, impairments in speech, vision, and
memory are not uncommon, as is marked changes in behavior and manifestations
such as diminished capacity to self-regulate.

It is very difficult to predict the extent of an individual's ultimate level
of recovery, but the evidence is very clear that, to be effective in helping an
individual recover from a brain injury and return to life as independent and
productive as possible, rehabilitation must be targeted to the specific needs of
the individual patient.

This piece of legislation is aimed at closing the gaps in current law that
have an effect of denying some veterans with severe TBI from achieving optimum
outcomes. I want to be very clear. Our VA facilities and the polytrauma centers
are providing the best care anywhere in the world. One of the things this piece
of legislation does is it codifies what and should be provided to those
veterans. That scope of services is limited, in many cases.

Veterans encounter two problems. First, all too common for families to be
advised the VA can no longer provide a particular rehabilitative service because
the veteran is no longer making significant progress as it is written now. But
ongoing rehabilitation is often needed just to maintain function, and
individuals who are denied maintenance therapy can regress and lose cognitive
gains they have made through a lot of hard work.

A second problem is veterans encounter getting help with community
reintegration, learning to live as independently as possible. VA's
rehabilitation focus relies almost exclusively on a medical model. That
assistance is critical but doesn't necessarily go far enough for some veterans
in providing range of support and services.

In contrast, other models of rehabilitative care meet TBI patients' needs
through services such as life-skills coaching, supported employment, and
community reintegration. These services are seldom made available to veterans.

H.R. 1855 would correct that. Specifically, it would clarify that the VA not
prematurely cut off needed rehabilitative services for an individual with a
traumatic brain injury, and that veterans with TBI can get the support they
need, whether those are health services or nonmedical assistance, to achieve
maximum independence and quality of life.

I understand that the VA expressed some concerns with some of the wording,
not because they don't want to achieve this and not because they don't believe
it is important, it was simply in some of the language. Those have been
addressed with a companion version that is being championed by one of our former
colleagues and a Member of this Committee, Senator Boozman and Senator Begich.
They have that piece of legislation over there; and it is my hope that if we get
the opportunity, we certainly have an amendment in the nature of a substitute,
Madam Chairwoman, that would address those very needs, and the VA would be
satisfied with that.

I am gratified by the broad support. You understand, Madam Chairwoman,
Ranking Member, and all Members of this Committee, the veterans' backs are
covered by those people sitting behind me, the veteran service organizations who
made this a top priority. I am really pleased with all of the support they put
into it.

And I would like to give one quote from the Wounded Warrior Project. Their
Executive Director, Steve Nardizzi, described this bill as "powerfully
addressing the often agonizing experience of wounded warriors who have been
denied important community reintegration supports and who have experienced
premature termination of rehabilitation services." As Steve said, "This bill
offers new hope to these warriors and their families."

So I look forward to responding to any questions, Madam Chairwoman. Again, I
thank you so very much for letting us bring this piece of legislation forward. I
will be glad to answer any questions, and I yield back.

Mr. BUCSHON. Thank you, Chairwoman Buerkle, Ranking Member Michaud, and
Members of the Subcommittee for the opportunity to come and speak to you today
about my draft legislation, the "Honey Sue Newby Spina Bifida Attendant Care
Act."

In April of this year, I was contacted by a constituent from New Harmony,
Indiana, Mr. Ron Nesler, on behalf of his stepdaughter, Honey Sue Newby. Honey
Sue's father was a Vietnam veteran exposed to Agent Orange, and she was born
with a complicated neurological disorder rooted in spina bifida, a congenital
condition in which the vertebrae do not form properly around the spinal cord.
The Veterans Administration has previously determined Honey Sue's condition is a
direct result of her father's exposure to Agent Orange in Vietnam and have
classified her as a Level III child, making her eligible to receive the same
full health coverage as a veteran with 100-percent service-connected disability.

In 2007, Mr. Nesler and his wife reached out to my predecessor, former
Representative Brad Ellsworth, regarding two issues they had been experiencing
with the VA. The first was an administrative burden requiring a letter from
Honey Sue's doctor explaining exactly how the treatment she sought was related
to her spina bifida. More often than not, this resulted in the VA denying
repayment until additional burdensome administrative procedures took place. For
example, Honey Sue needed surgery on her mouth after seizures caused her to
grind her teeth to nubs. The VA originally denied payments for the procedure,
saying the doctor's letter did not clearly make the case that this result was
from her condition.

Secondly, Honey Sue's parents are aging and experiencing health problems.
Currently, the only long-term services the VA will pay for is nursing home care
for individuals like Honey Sue. As a physician, I know that nursing home care is
both extremely expensive and inappropriate for what Honey Sue needs. Individuals
with spina bifida have a diverse range of needs. Although no two cases of spina
bifida are ever the same, the National Spina Bifida Association confirms the
majority of these individuals can live independently if they have the proper
habilitative care in order to develop, maintain, or restore their functioning.

Former Representative Ellsworth's bill, H.R. 5729, was written to address
both of these issues and on May 20, 2008, was passed by a voice vote in the
House of Representatives and was later added to S. 2162, the Veterans Mental
Health and Other Care Improvement Act of 2008, and was signed into law by
President Bush on October 10, 2008.

Since then, the VA has recognized and alleviated the administrative burdens
but has not properly interpreted the "habilitative care". Title 38 of the U.S.
Code defines habilitative care as professional, counseling and other guidance
services and treatment programs—other than vocational training under section
1804 of this title—as are necessary to develop, maintain, or restore, to the
maximum extent practicable, the functioning of a disabled person. Under this
language, I believe the VA is misinterpreting the law and its intent as it
concerns individuals with type III spina bifida who simply need supervisory, or
as we put in the draft legislation, home and community-based care.

The purpose of this draft legislation is to clarify title 38 to allow
individuals with spina bifida the appropriate and cost-effective care that they
deserve. The intended result allows individuals to take advantage of home and
community based care for those that do not need constant medical care. The term
"home and community based care" is used in a definition of habilitative care in
section 1915 of the Social Security Act, and this legislation is modeled after
and aims to create consistency for that definition within VA services.

Again, thank you for consideration of the legislation. It is a pleasure to be
here and an honor to be here, and I am happy to answer any of your questions.
Thank you.

I will now yield myself 5 minutes for questions. I will start with Mr. Grimm.

First of all, thank you for introducing this legislation. I think that we all
understand, and as time goes on we understand even more, the emotional toll that
these wars have on those returning home. This legislation is a good opportunity
and a good mechanism for us to look at ways that we can most effectively treat
those coming home with PTSD.

One of the questions that was raised by the Veterans of Foreign Wars (VFW)
regarding H.R. 198, and I would like you to just respond to this if you could,
they said, "We do not believe a VA medical center is the right environment for a
pilot program involving dog training. We believe the idea behind this
legislation would be better achieved through established private-sector
organizations with sufficient oversight by the VA."

Could you comment on that for me, please?

Mr. GRIMM. Certainly. I disagree with the VFW because it is a pilot program.
Ultimately, I think that this pilot will be very successful, and it will grow,
and then it should be more community based and have much more private-sector
interaction.

But for the beginning stage, to take this from where it is now as purely a
pilot within 3 to 5 sites, I think that we need the proper oversight,
assessment, and valuation that can be better achieved in an environment like the
VA setting. I also think it will be cheaper right now to be able to do that and
will yield better assessments in valuations because of the controlled
environment.

Now, once it is proven successful and we want to expand this program
throughout the United States, then I would agree that it should be more
community based and have much more interaction with private industry and allow
that to grow. And I think then it would actually be cheaper—it will be more
cost-effective, I should say, for communities to get more involved. But, right
now, in its infancy stages, I think that we need the control of the environment
to fully assess and evaluate the efficiency and benefits of the program.

Ms. BUERKLE. Thank you.

And just as a follow-up, with the dog therapy program, have they identified
cases of PTSD where it may be more or less successful, which veterans may
benefit from this treatment or may not? Have they made any distinction
about the cases of PTSD and who might benefit from this program?

Mr. GRIMM. That is an excellent question, Madam Chair. My experience so far
has been that, amazingly, the work with these animals, with these dogs, has
helped already a very, very wide spectrum of cases.

One in particular comes to mind where a young soldier returned and would not
speak with anyone, did not want to speak, was pent up with a tremendous amount
of anger, went for counseling, would not speak to the counselor and was leaving.
On his way out from counseling, walking out, there was someone walking with a
dog, and the dog went up to him, and he pet the dog. It was the only interaction
that this veteran really had. He wouldn't speak with anyone else, didn't want
to, he shut the world out except for this dog.

And someone there noticed how perceptive the dog was to go over to this
soldier and the interaction they had in just a few minutes. And they contacted
the veteran again and said, would you come back and be willing to work with some
of our dogs? And it just completely changed that veteran's life.

So I think there is no way to say that there is one specific type of veteran
that has post-traumatic stress. It really is a very wide spectrum, which is why
I think this program is going to have tremendous success.

I yield back.

Ms. BUERKLE. Thank you very much.

Mr. Walz, first of all, let me thank you as well for bringing forth this
piece of legislation and making sure that there is no institutional barriers
between the veterans and the care they need with TBI. There has been some
concern regarding the term "quality of life." that the VA will exceed their
statutory mission. Can you speak to that? And I am hopeful that we can, in
amendment language, address that issue.

Mr. WALZ. Yes. You are absolutely right. That was the piece of legislation,
the qualifying language on quality of life. And again, as I said, not because
the VA doesn't want to achieve the highest quality of life. They think it is
more subjective instead of an objective measure of what they are doing. That
word was struck from the Senate version, and they are agreeable for all the
other procedures that went through or all the other barriers that were there
coming down. The amendment that we would offer would be that identical language,
and the Senate was acceptable to the VA.

Ms. BUERKLE. Thank you very much.

I now yield to the Ranking Member, Mr. Michaud, 5 minutes for questions.

Mr. MICHAUD. Thank you very much, Madam Chair.

I want to thank the three panelists this afternoon for taking the time to put
forward legislation that will definitely help our veterans get through life and
I really appreciate your willingness to do that and for your service to this
country as well. I have no question for the panelists, so I yield back.

Ms. BUERKLE. Thank you, Mr. Michaud.

Mr. Runyan. I now yield 5 minutes to the gentleman from New Jersey.

Mr. RUNYAN. Thank you, Madam Chair; and thank all of you for bringing these
bills in front of us.

Mr. Grimm, as I am a co-sponsor on the piece of legislation, I agree with
much of what you are trying to do.

I just wanted to really say for the record that I actually, probably back in
February, had a constituent of mine who is a Marine, much like yourself, come to
my district office with his dog. And to listen to his wife tell the story of how
it has changed his life, for him to be able to go out and interact with people.
It almost gets to the point where the dog is a conversation piece that gets him
back into society. And I have seen the gentleman three or four times since then
in many different settings, whether it is out where he is actually heading a
similar program trying to do it himself.

But, again, we lack the funding to do it, and I think that is kind of the
sticking point here.

But to hear his story and to go actually on a camping trip with my daughters,
and he happened to be there at the same one, and to hear his wife come to me at
the next event we were at and said he wouldn't have been able to do that a year
ago—just kind of place that.

Because we always talk about the positive impact, whether it is veterans or
seniors, that animals have on them. I applaud you for getting out in front of
this, because I think it is worthwhile. I think, as you said in your statement,
though, figuring out how we are going to pay for it is ultimately going to be
the decision about how we are going to do this. Because there is a lot of upside
to it, so I thank you for that.

And, also, Mr. Walz, thank you for what you are trying to do there. I have
experienced and I deal with it myself. When you talk about brain injuries, I
don't think we necessarily understand the long-term, life-term commitment that
we have to have. And to really say somebody has totally recovered and we are
going to stop treatment I don't think is reflective of that commitment. I have
seen many of my past colleagues in my past career with brain injuries be 30,
40 years old and have full onset dementia and can't function.

It brings back a gentleman that I played against that was working on Wall
Street and had to quit because he couldn't function anymore. So we really do
have to not turn him away and simply say we have got them to the level they are
at and then that's it.

There have been many other instances of that where I have had people come and
visit me. We have come so far with things like Down Syndrome where they were
just trying to get these kids just to get out of high school. I have had several
people come to my office and say, my son wants to go to college, and there is
nothing there for them.

We really have to take a long-term approach to this, and I just wanted to
thank all of you for bringing this up.

I yield back.

Ms. BUERKLE. Thank you, Mr. Runyan.

I yield 5 minutes to Mr. Donnelly.

Mr. DONNELLY. Thank you, Madam Chair.

I just wanted to thank my fellow colleagues for your efforts on behalf of our
veterans and for bringing these bills forward. Thank you very much.

Ms. BUERKLE. Thank you.

I yield 5 minutes to Dr. Roe.

Mr. ROE. Thank you. And also thank you for your service and thank you for
being here today.

And, Congressman Grimm, I will be on your legislation or I won't ever be able
to go home. I have a wife that has done pet therapy for years, and it is
tremendously beneficial for seniors. Certainly don't see any reason it
wouldn't be beneficial.

We already know—we had a veteran in our office just this past week that
brought his dog. It was a bomb dog in Afghanistan, and now he is with this
Marine and it helps him to know when he is going to have seizures; the dog can
pick it out. So they are tremendous amounts of help, and so certainly I will
support that.

And you are correct about finding the resources. One of the things I
think we have is a commitment to our soldiers coming home to understand that we
have a lifetime commitment to them, not a 1 week or a 1 year or a 5 year. We
have for these men and women who go, as you have and Sergeant Major Walz has, to
give your time and your treasure for this country, this country has a lifetime
commitment, period, to taking care of that, whatever it may be.

So, having said that, I didn't hear—I read your testimony, Sergeant Major.
But if you would help me a little bit here. Would there be any part in this—we
have a brain injury—I won't go into why it is there—but there is a brain injury
center, a private brain injury center, in our area that takes care of traumatic
brain injury from the most severe to mild injury. Is there any way or
any—I guess, way that a veteran could be treated on the private side with your
Act?

Mr. WALZ. Well, this one addresses, Dr. Roe—and, again, thank you. Thank you
for your service and your unwavering commitment to this Committee of getting
things done. This addresses the VA's responsibility, but it does deal with that
reintegration piece of trying to get them back into the community. And at that
point in time, we are certainly very interested to see what happens when
these—and many of them, as you know, are rural veterans, where they move from
the polytrauma centers that are doing fabulous work, and trying to keep this
maintenance of effort to keep them out or, as Mr. Runyan said, to move them on
in this rehabilitation is critically important.

So we didn't address it in the specifics at that point, because, again, as
Mr. Grimm said, we are looking at cost benefits, and this one the VA shows as no
added cost. But it does start to bring to bear those outside resources that can
be there to move them back in. So I am certainly interested in looking at that
with you and see how we can do that, of making sure all those resources, public
and private, are brought to bear to the benefit of those veterans.

Mr. ROE. Certainly in young people who have brain injury we are just learning
how much recovery you can experience, and it can be very dramatic. I mean, I
have seen—and it may not be for someone who is right there side by side, day by
day. But when you are seeing it, as I did, we see a patient in 6 months or 3
months or year intervals, you would notice dramatic changes.

And that was what I learned over time, was it used to be when you had a brain
injury that was just the way—you were just stuck with that the rest of your
life—that is not true anymore. And all of these innovative ways, whether it is
with pet therapy or whether it is with innovative things that we are learning,
we should be doing that. And the VA ought to be at the forefront, since there
are so many of our veterans that have had brain injuries. And, again, it's a
lifetime commitment.

I can't thank you all enough for bringing these here and taking your time to
be here and testify in front of this Committee, and I yield back.

Ms. BUERKLE. Thank you, Dr. Roe.

Unless any of my colleagues has additional questions, again, on behalf of all
of us, thank you very much for being here today, for taking the time and the
energy to act on behalf of our veterans. And, to all of you, thank you for
your service to this country.

Our first panel is excused, and we would ask that our second panel join us at
the witness table.

Good afternoon. With us on our second panel are representatives from our
veteran service organizations.

We have Mr. Shane Barker, the Senior Legislative Associate for the Veterans
of Foreign Wars. Good afternoon.

Ms. Joy Ilem, the Deputy National Legislative Director for the Disabled
American Veterans (DAV). Welcome to our hearing.

Dr. Thomas Berger, the Executive Director of the Veterans Health Council for
the Vietnam Veterans of America (VVA). Welcome, Dr. Berger.

Mr. Carl Blake, the National Legislative Director for the Paralyzed Veterans
of America (PVA). Welcome.

And Christina Roof, the National Acting Legislative Director of AMVETS.

Good afternoon to all of you. Thank you for joining us this afternoon, and,
Mr. Barker, we will begin with you.

Mr. BARKER. Madam Chairwoman, Ranking Member Michaud, and Members of this
Committee, on behalf of the more than two million members of the Veterans of
Foreign Wars of the United States and auxiliaries, thank you for the opportunity
to present our views on today's legislation.

The VFW does not support H.R. 198, the "Veterans Dog Therapy Training Act."
Helping veterans with post-traumatic stress by offering them a therapeutic dog
training class is indeed a laudable goal. We believe it would be better
achieved through public-private partnership with Congressional oversight.

We also believe that such a benefit should not be anchored to VA medical
centers. The nature of this service does not readily align itself with the
provision of medical care to veterans, and we do not want it to complicate the
care those medical centers provide.

The VFW does support H.R. 1154, the "Veterans Equal Treatment for Service
Dogs Act." The use of medical service dogs among veterans is increasing. They
serve a critical role as a VA-recognized prosthetic in helping to promote
independence. This legislation opens the doors at VA facilities for veterans to
utilize such service dogs, broadening VA policy that currently allows only
seeing eye dogs into medical facilities. Service dogs are helping our
veterans, and they shouldn't have to leave them at the door when they come to VA
for medical care.

The VFW supports H.R. 1855, the "Veterans Traumatic Brain Injury
Rehabilitative Services Improvement Act of 2011." This legislation ensures
better TBI treatment plans by focusing on an injured veteran's independence and
quality of life while also stressing improvements to their behavioral and mental
health functioning.

We all agree that TBI patients deserve more than mere treatment of the
physical wounds of war. It has been made painfully clear that even mild TBI can
cause emotional, cognitive, and behavioral complications; and this bill would
guarantee treatment for these conditions as well.

We thank the Chairwoman and the Ranking Member for their work on H.R. 2074,
the "Veterans Sexual Assault Prevention Act," and we are pleased to see this
Committee continuing to move this forward. The VFW will continue to staunchly
advocate for a zero tolerance policy, because veterans should never have to
visit a VA medical facility with concerns about their personal safety.

The VFW also supports H.R. 2530. This legislation will eliminate the system
currently in place to reimburse State homes for nursing home care provided to
veterans. It would require the VA to negotiate adequate payment structures with
an individual State home prior to entering into agreements for services. This
bill has broad stakeholder support, and we strongly believe that it will put
many complications with the current system to rest.

The VFW strongly supports the "Honey Sue Newby Spina Bifida Attendant Care
Act." Honey Sue Newby is entitled to VA care because she is the child of a
Vietnam veteran and is afflicted with spina bifida. Her condition renders
her unable to care for herself, and the VA considers her disability on par with
the 100-percent service-connected totally disabled veteran, yet her provision of
care is substantially lower. This bill provides needed relief by greatly
broadening the types of care that she and other similarly affected children can
receive and by redefining home care to expand services and offer financial
incentives to employ a live-in caregiver. We strongly support passage of this
legislation.

Finally, the VFW supports the "Veterans Health Care Facilities Capital
Improvement Act of 2011." This legislation will remedy a handful of serious
structural concerns at individual VA facilities and expand authorizations to
enhance facilities in other high-demand locales.

We support the extension of current enhanced use lease authorities in this
bill. However, we are concerned that removing provisions to ensure that they
contribute to the mission of VA will diminish services to veterans. Added
revenue is already being cited in some current leases as the main factor
contributing to VA's mission, so we believe these provisions are essential to
the continued success of enhanced use leases.

This bill would also require VA to detail expected costs to make a facility
fully usable for its intended purposes, instead of merely requesting the funds
to build the bare bones facility. We believe Congress should know up front how
much VA needs to furnish and supply the facilities it intends to build.

Madam Chairwoman, this concludes my statement. I would be happy to answer any
questions that you or the Committee may have.

Ms. ILEM. Thank you, Madam Chairwoman, Ranking Member Michaud, and Members of
the Subcommittee. Thank you for inviting me to testify on behalf of the Disabled
American Veterans at this legislative hearing. We are pleased to present our
views on the five numbered bills and two draft measures before the Subcommittee
today.

DAV does not have an approved resolution from our membership that supports a
pilot program as proposed in H.R. 198, the Veterans Dog Training Therapy Act, so
we are unable to take a formal position on this bill. We do, however, recognize
that working with service animals could play an important role in promoting
maximum independence and improved quality of life for persons with disabilities
and that a pilot program such as the one proposed in this measure could be of
benefit to certain veterans.

The next bill for consideration, H.R. 1154, the "Veterans Equal Treatment for
Service Dogs Act," would prohibit the VA Secretary from restricting the use of
service dogs by veterans on any VA property that receives funding from the
Secretary. DAV does not have a resolution on this specific topic either.
However, we note VHA recently published a national policy directive on
admittance of service and guide dogs into VA health care facilities.
Unfortunately, in the last several months, we have received a number of
complaints from DAV members suggesting actual local policy as enforced by
individual facilities or network management may differ markedly from VA's
national policy.

We believe the current national policy and local enforcement of it could
accomplish the goal of this measure. We suggest the Subcommittee ask the VA what
actions have been taken since the directive was issued to ensure current policy
is fully implemented and is enforced consistently throughout the system. Based
on their response, the Subcommittee may want to choose to provide oversight to
ensure VA's standardization of the existing policy or move forward with
enactment of this measure, to which DAV would have no objection.

DAV is pleased to support H.R. 1855, the "Veterans Traumatic Brain Injury
Rehabilitation Services' Improvements Act of 2011." This measure aims to clarify
the definition of rehabilitation and to strengthen VA's mandate to sustain gains
made in the rehabilitative process in veterans who have incurred serious
traumatic brain injuries.

DAV members have approved a national resolution calling for comprehensive
treatment and more research to ensure veterans with TBI receive the best care
possible. This bill aims to fulfill the goals of maximizing an individual's
independence and quality of life and is fully consistent with DAV resolution
215. For these reasons, we urge the Subcommittee to recommend its enactment.

Madam Chairwoman, we appreciate your introduction of H.R. 2074, the "Veterans
Sexual Assault Prevention Act." As indicated in our previous testimony to the
Subcommittee on this issue, veterans, VA staff, and visitors should be assured
of a safe environment at VA health care facilities. This bill firms up VA's
requirement to document, track, and control the incidents of sexual assaults
that occur on properties and grounds of the VA. We believe the measure reflects
GAO's recommendations calling for greater transparency, accountability, related
to the reporting of sexual assaults and other incidents affecting the safety of
veterans and VA staff.

H.R. 2530 would revise the methodology used to reimburse State veterans homes
that provide nursing home care for veterans with service-connected disabilities
rated 70 percent or greater or for veterans who need nursing home care due to a
service-connected disability. This bill is intended to restore the original
intent of section 211 of public-law 109-461, which was enacted in order to
authorize VA to place 70 percent service-connected veterans in State homes and
to reimburse the homes at rates comparable to those received by contract
community nursing homes. DAV commends the bill's sponsors for their continuing
efforts to ensure their highest-priority veterans have the option of entering a
State home to meet their long-term care needs, and we recommend enactment of
H.R. 2530.

DAV has no resolution from our membership on the specific issues addressed in
the two remaining draft bills under consideration by the Subcommittee, the
"Honey Sue Newby Spina Bifida Attendant Care Act" and the "Veterans Health Care
Facilities Capital Improvement Act." However, DAV is supportive of assisted
living options as an alternative to institutionalized care, and we appreciate
the Subcommittee's continuing support of VA's capital infrastructure needs.
Therefore, DAV would offer no objections to enactment of either bill.

Madam Chairwoman and Members, this completes my testimony, and I am happy to
answer any questions you may have.

Dr. BERGER. Chairwoman Buerkle, Ranking Member Michaud, and distinguished
Members of the Subcommittee, Vietnam Veterans of America thanks you for the
opportunity to present our views on the pending legislation for veterans and
their families.

H.R. 198, the "Veterans Dog Training Therapy Act," although VVA generally
supports this legislation, we have a couple of questions. One is, what are the
certification standards that will be used to ensure that the animals can perform
the essential service dog skills, which are mentioned specifically in the Act?
There are 11 of them.

The second question we have is what quantitative metrics or measurements will
be used to measure the impact of the service dogs on the psychosocial mental
health and physiological disorders suffered by the participating veterans?
Again, those 11 items that are referred to in the bill itself.

H.R. 1154, the "Veterans Treatment of Service Dogs Act," VVA supports this
legislation but again asks the question in the larger sense, what constituents
certification of one's animal as a service dog? As you are well aware, probably,
the VA issued some proposed regulations back in June that call for certification
under the terms of a couple national or international organizations. We want to
know how those are going to work relative to admission of animals into the VA as
service dogs.

H.R. 1855, the "Veterans Traumatic Brain Injury Rehabilitation Services Act,"
we strongly support this legislation. It is very clear that Command Sergeant
Major Walz understands the necessity for a broadly integrated and individualized
psychosocial mental health and physical treatment plan and service in order to
maximize the quality of long-term care for our veterans suffering from TBI.

H.R. 2074, the "Veterans Sexual Assault Prevention Act," VVA strongly
supports this legislation as an initial effort to address and correct the
failures of the VA from protecting and safeguarding our veterans in VA
facilities, as noted in the June, 2011, GAO report.

H.R. 2530, which will provide for increased flexibility in establishing rates
for reimbursement of State homes, et cetera, we have already heard the long
title of that. This proposed legislation to be introduced by Congressman Michaud
would correct problems that had come about as a result of Public Law 109-461;
and, as you have heard from my colleagues, this legislation will achieve the
goals of the original law from a couple of years ago, which was to provide
veterans with service-connected disabilities rated 70 percent or greater with an
additional option which may be more convenient, provide better care, and usually
costs less to the Federal Government in the same care provided through VA
operated nursing homes or contract community homes.

Now, the "Honey Sue Newby Spina Bifida Attendant Care Act" draft legislation,
we strongly support this legislation, as it will provide a decades-long-overdue
service and services to the child of the Vietnam veteran parent suffering from
spina bifida.

I had the opportunity to meet Honey Sue a couple of weeks ago in
Indianapolis, and I can tell you that this will be welcome by not only Honey Sue
herself, but by her parents.

The "Veterans Health Care Facilities Capital Improvement Act of 2011" draft
legislation, although this legislation calls for needed construction
modifications at a number of VA medical facilities, VA cannot at the present
time support this legislation in its present form as it is unclear as to whether
the proposed changes suggested in section 6, Modification of Department of
Veterans Affairs Enhanced Use Land Authority, will eliminate any possible
breaches of VA fiduciary duty for leasing property to private entities, as has
been alleged to have occurred at the West Los Angeles Medical Center and
Community Living Center campus.

Once again, on behalf of VVA National President John Rowan, our national
officers board, and membership, I thank you for your leadership in holding this
important meeting on these pieces of legislation; and I also thank you for the
opportunity to address you today on behalf of America's veterans. Thank you.

Ms. BUERKLE. Thank you very much, Dr. Berger. Mr. Blake, would you like
to proceed?

STATEMENT OF CARL BLAKE

Mr. BLAKE. Chairwoman Buerkle, Ranking Member Michaud, Members of the
Subcommittee, on behalf of Paralyzed Veterans of America, I would like to thank
you for the opportunity to be here to testify today on the proposed legislation.

With regards to H.R. 198, while PVA has no specific position on the bill, the
"Veterans Dog Training Therapy Act," we believe that it could be beneficial
therapy for veterans dealing with post-traumatic stress disorder (PTSD) and
other mental health issues.

PVA supports H.R. 1154, the "Veterans Equal Treatment for Service Dogs Act of
2011. While we believe this legislation should be unnecessary based on the
provisions of section 504 of the rehab act, the actions of the VA clearly
demonstrate the need for this legislation.

PVA fully supports H.R. 1855, the "Veterans Traumatic Brain Injury
Rehabilitative Services Improvement Act." If enacted, H.R. 1855 would ensure
that long-term rehabilitative care becomes a primary component of health care
services provided to veterans who have sustained a traumatic brain injury.
Because all of the impacts of TBI are still unknown, this legislation to expand
services and care, providing for quality of life and not just independence, and
emphasizing rehabilitative services is important to the ongoing care of TBI
patients. It is imperative that a continuum of care for the long term be
provided to veterans suffering from TBI. This bill will address the intricacies
associated with TBI and help veterans and their families sustain rehabilitative
progress.

PVA fully supports H.R. 2074, a bill that would require a comprehensive
policy on reporting and tracking sexual assault incidents and other safety
incidents that occur at VA medical facilities. PVA believes policy mandates that
specifically outline sexual assaults within the VA should be handled are long
overdue. The implementation of policies involving sexual assault will reinforce
veterans' confidence in the VA's ability to provide a safe environment for care.

PVA recommends that the proposed legislation require the leadership of each
Veterans Integrated Services Network (VISN) to be responsible for the
centralized reporting, tracking, and monitoring while also requiring the VISN to
provide the tracking reports to VA's Central Office. Additionally, PVA
recommends that VA provide clear and concise policy guidance that includes a
specific time frame in which frontline VA personnel responsible for the initial
processing of assault claims must begin processing those reports.

PVA generally supports H.R. 2530 to allow for increased flexibility in
establishing rates for reimbursement for State veterans homes. As we understand
it, the VA and the National Association of State Veterans Homes have begun
discussions about developing a reimbursement agreement that is satisfactory to
both parties. However, this legislation will give the VA the authority to
further develop appropriate reimbursement methodology.

PVA supports the draft "Veterans Health Care Capital Facilities Improvement
Act." VA's significant inventory of real property and physical infrastructure is
truly a remarkable asset in the provision of health care and benefit delivery to
veterans. At the same time, these facilities must be properly managed and cared
for to ensure that the investment made in the use of these buildings and
properties coincides with the benefit derived from their use.

With regard to this bill, I would only offer one bit of caution or perhaps a
question. I noted in the legislation that proceeds that are generated through
enhanced use lease and other authorities will be now transferred into the
major/minor construction accounts which we think is a very good idea, given the
backlog of projects that exist and the need for needed funding in those
accounts. However, that money is now presumably being transferred away from the
medical care collections fund which is where it is currently being sent. And so
I think the Subcommittee needs to look at how now putting this money into the
major/minor construction accounts may affect medical care collections estimates
and overall the effect on the health care accounting of the VA.

With that, Madam Chairwoman, Ranking Member Michaud, I would like to thank
you for opportunity to testify, and I would be happy to answer any questions
that you have.

Ms. ROOF. Madam Chair, Ranking Member Michaud, and distinguished Members of
the Committee, on behalf of AMVETS, I would like to extend our gratitude for
being given the opportunity to share with you our views and recommendations
regarding these very important pieces of legislation today. You have my complete
statement for the record, so today I will be specifically speaking to H.R. 198
and H.R. 1154.

AMVETS supports H.R. 198, the "Veterans Dog Training Therapy Act." AMVETS
lends our support to the updated language of H.R. 198 that will be submitted in
the Committee markup. AMVETS believes the updated language will help ensure that
H.R. 198 provides veterans only the highest quality of care.

By way of background, AMVETS has worked with Paws with a Cause and Assistance
Dogs International accredited agencies to help provide service dogs to disabled
veterans, for over 25 years. Through this partnership, AMVETS has witnessed
firsthand the incredible changes that occur in a veteran's life when introducing
a dog into their overall treatment plan. These changes are often illustrated
through a veteran's ability to maintain a higher quality of life and greater
mental health improvements when compared to veterans undergoing clinical care
alone.

H.R. 198 and a dog that will be included in the study have the ability to
break down barriers in a veteran's world by shattering public stigmas and
increase a veteran's overall well-being by reigniting their purpose through
allowing them to help—to continue to serve their—excuse me—to continue to serve
their country by assisting their fellow comrades. Again, AMVETS is happy to lend
our support to H.R. 198.

AMVETS strongly supports H.R. 1154, the "Veterans Equal Treatment for Service
Dogs Act." In 2009, I began to personally play an active role in AMVETS 30-plus
years experience in working with disabled veterans and service dogs. I could
never imagine that 2-1/2 years later I would be sitting here testifying on a
piece of legislation that is in dire need of being signed into law and
implemented without any further delay. This piece of legislation I am speaking
about is H.R. 1154.

AMVETS believes this cost-free piece of legislation will permanently
eliminate an often overlooked and unwarranted hurdle to care disabled veterans
are currently experiencing when seeking necessary VA care and services. To date,
title 38, part one, subsection 1.218(a)(11) states: "Dogs and other animals,
except seeing eye dogs, shall not be brought upon property except by as
authorized by the head of each facility or designee." AMVETS finds the aforesaid
language in title 38 to be inconsistent and outdated when compared to the
sections of title 38 it is to govern.

While numerous parts of title 38 are constantly updated to reflect the health
care needs of today's wounded warriors, this section of title 38 has been
overlooked and, thus, has failed to be updated since July of 1985. This outdated
law resulting in disabled veterans utilizing VA-approved service dogs as a
prosthetic device to be denied entrance into Veterans Affairs Medical Centers
(VAMCs) and Community-Based Outpatient Clinics (CBOCs) they depend on for their
life-sustaining care.

One of these veterans who has personally experienced this barrier to care is
AMVETS member Mr. Kevin Stone and his service dog, Mambo, who are in attendance
today and we thank him. AMVETS believes disabled veterans such as Mr. Stone
using a service dog as a prosthetic device must have the same access rights to
VA care and facilities already currently afforded to blind veterans using guide
dogs.

During the next panel, VA officials will argue H.R. 1154 is unnecessary due
to the directive they have already published. Moreover, VA officials have
recently stated H.R. 1154 was unnecessary due to the fact that under existing
statutory authority under title 38, section 901, VA to implement national policy
followed its VA properties. AMVETS believes that while VA is correct in
outlining the authorities granted by section 901, we must respectfully disagree
with VA that H.R. 1154 is unneeded or is too narrow given the scope of its
intent.

VA's years of inaction in addressing this easily correctable hurdle to care
clearly illustrates the strong need of change that is proposed by H.R. 1154, and
while AMVETS applauds VA's recent publication of a directive seeking to
temporarily address this matter, we still believe there are numerous loopholes
that need to be closed to guarantee all veterans receive the care and services
they need regardless of the disability and regardless of the prosthetic device
they use.

Through our close work with VA and the 111th Congress, and now the 112th
Congress, AMVETS has done everything in our power to remove this hurdle to care
for disabled veterans. Now, AMVETS has reached a point where only you, the
Members of the 112th Congress, can, once and for all, end this vicious cycle of
veterans being denied care through your swift and bipartisan passage of
H.R. 1154. AMVETS, VSOs and the veterans communities look to you to please
finally close this loophole and hurdle to care for veterans.

Madam Chair and distinguished Members of the Committee, AMVETS again thanks
you for inviting us to share with you our views and recommendations on these
very important pieces of legislation. This concludes my testimony. I stand ready
to answer any questions you may have for me.

Ms. BUERKLE. Thank you very much, and thank you to all of our witnesses for
your testimony here this afternoon.

At this time, I would like unanimous consent from the Committee to allow
lifelong Texan, our colleague, Mr. Carter, to join us here this afternoon, to
sit at the dais and ask questions of the panel. Without objection, so ordered.

And with that, I would like to yield my 5 minutes to Mr. Carter for his
questions.

STATEMENT OF HON. JOHN R. CARTER, A REPRESENTATIVE IN
CONGRESS FROM THE STATE OF TEXAS

Mr. CARTER. Thank you, Madam Chairman, and I didn't hear all of the testimony
as to where everybody stood on this. I am the sponsor of H.R. 1154, and when I
started this whole process, Mambo and his friend came to see me, along with
quite a few other of the dogs.

And let's be honest about how you view this. What exactly do these dogs
do if they are not seeing eye dogs, which we are all used to since Second World
War, what purpose do they serve? And as I listened to the conversation with
these folks, I realized the old saying that my wife has written on the wall in
the Dutch language, it says that it is not the mountain that you have to climb
that gets you, it is the grain of sand in your shoe.

And what these dogs give to these military folks is they help them to cope
with something that is a disability for them. In some instances, they have
a critical guide component like they do with dogs for the visually impaired. In
others, they have a psychological component. You know, it was Harry Truman
who said if you want a friend in Washington you better buy a dog.

But the truth is, these dogs are a friend—not only a friend, they are their
partner—they are their partner in moving through life, and when they get to the
door of the place they are seeking medical help and they leave their partner
outside the door, they lose the confidence that partner gives them, and they
lose, in some instances, the reaction to sounds that they can't catch, if it is
hearing loss. That dog knows how to deal with them if they are approaching
seizure times, and they are likely to have seizures. And of course, if they have
limbs, I have watched them use the dog to help them gain their balance as they
stand up.

And so from that, to us it may be a grain of sand, but to them it is their
partner that is getting them through the day, and to me, it just seemed a real
shame because we are already admitting dogs to the facility anyway for people
who are blind, and then to say, well, we are not going to allow them for these
other people who are relying on them just as desperately to enter this facility,
that is why I took up this project. That is why I think it is a worthy project.
I think I will ask, Ms. Roof, isn't that the general concept of what this whole
AMVETS program is?

Ms. ROOF. Yes, sir. As I said, you are exactly right in everything these dogs
give. These dogs are also, such as Mr. Stone, his prosthetic device. As you
said, he could not many times stand up, or he would lose balance without that
dog, and you had mentioned as well, VA is already paying benefits to many of
these veterans for the upkeep of this dog as a prosthetic device. So it is quite
unfortunate and sad honestly that they have to leave them at the door.

Mr. CARTER. Well, thank you, and I don't know—she is the only member of the
panel I heard. So I better yield to other members of the panel to ask questions
about what was said. Thank you.

Ms. BUERKLE. Thank you very much, and I yield 5 minutes to the Ranking
Member, Mr. Michaud.

Mr. MICHAUD. Thank you, Madam Chair. This question is for everyone on
the panel, starting with Mr. Barker.

We asked for the report and was actually shocked when you look at the number
of sexual assaults and rapes. We saw the report and are very supportive of the
legislation before us. We also have heard a lot of instances in the last few
years as far as within VA facilities themselves.

So my question is, what is the most important change that could be
implemented to improve the culture within the VA to make it more accommodating
toward female veterans and women in general?

Mr. BARKER. The position of the VFW on this is clear, I think. Our written
testimony shows that we feel the lack of a holistic VA-wide training program
that is required for all VA employees to go through and be—some kind of
verification process that every VA employee has gone through, this training is
required.

We have talked a lot about VISN-to-VISN different policies, and the culture
is not going to change overnight on this issue. It won't change at all unless
there is some sort of direction from the very top that makes very clear that
there is no room for this kind of incident to happen at any VA facility. It
really needs to come from the very top, and it needs to be fully consistent for
all VA employees.

Ms. ILEM. We appreciate the question. Just this past weekend, VA had
their national training summit for women veterans. We had over 750 women
veterans attend, along with VA's women veteran veterans program managers. I
think one thing that we consistently heard in talking with women veterans over
the time of the event was that they would like to see these changes, and
actually Secretary Shinseki made a call to action to women to submit to him what
needs to be fixed, first and foremost, and what can VA do.

This came up in the discussion with women veterans over and over, for
example, I don't feel comfortable going a VA facility; someone's leering at me,
talking to me; I need to go to my mental health appointment, but I am not
comfortable in there—just a variety of anecdotes of just overall unwelcome
feelings.

I think some of the things that we need—could do right away would be—first of
all, the education piece, making it a top priority in VA to make sure all of the
staff and clinicians are educated, and if they see things happening, they have
to intervene to make our women veterans feel welcome.

They need to have focus groups they need to listen, the voices of women
veterans out there, that women veterans can say this is the particular problem
in this facility that I am encountering.

And I think with regard to the legislation that is being proposed, having it
done consistently, if someone reports a sexual assault or an incident, it needs
to be taken seriously and it needs to be handled appropriately. I mean, reading
just briefly some of the testimony from other organizations—actually it was SWAN
(Service Women's Action Network) I was just reading prior to the hearing. They
gave some very prime examples when someone did do the right thing reporting, and
yet it was still not taken seriously or these people are still in employment in
VA. Thank you.

Dr. BERGER. I would agree with my colleagues, particularly Mr. Barker's
comments, but it starts with leadership and I would also go as far as to say
that if there are lapses found in the reporting system in any shape or fashion,
that the person responsible, meaning the facility director, is reprimanded in
some fashion, and that may mean some kind of financial. If that is the only way
to get people to pay attention, then we need to do it that way. We need
accountability. We need accountability.

I, too, was at the women's conference last weekend, and I think at some point
down the line that General Shinseki's asking the women for comments, those need
to be turned over, okay, so that we can see how to mesh those in with what we
see in front of us today to see if it is really working. So those are some of
the things that I could recommend.

Mr. BLAKE. I don't know that there is a whole lot more I could say other than
I would like to second both what Ms. Ilem and Mr. Berger said. I would suggest
an education and training side is of the utmost importance, particularly as it
relates to the VA staff. The thing to understand is that there is a still
challenge of overcoming the culture of the patients. I mean, you can't change
the way patients are in some cases, but you can certainly affect the way that
culture is managed by the VA and its staffing.

And I couldn't agree with Mr. Berger more than the issue about
accountability, which goes to my comments about reporting requirements that
should be on the various levels within VHA. It can't be just about, well, this
incident occurred, and we develop a report, and then that is the end of it. It
needs to be followed and tracked and there has to be ramifications if someone
doesn't take appropriate steps because these are serious incidents and they need
to be treated as such.

Ms. ROOF. AMVETS concurs with all of my colleagues' statements. You know,
this was so upsetting when this came out, and the more I talked to our members,
come to find out, I actually spoke to three different female AMVETS members that
had experienced a sexual assault. It was reported. However, they felt like
they never got closure. So I thank you all for introducing this very, very
important piece of legislation. Thank you.

Ms. BUERKLE. I now yield Mr. Roe 5 minutes for questions.

Mr. ROE. Thank you, Madam Chairman, and I want to thank you for introducing
this piece of legislation. I think, Dr. Berger, you hit it right on the head,
that there should be no tolerance. There should be a change of culture, and it
comes from the top. I agree with that 100 percent, that the leadership—when you
have no tolerance for that type of behavior, it won't happen. And it is a
criminal offense in many cases as well. They can be prosecuted by a criminal
court system, and it is a very serious offense, and so I want to thank you for
doing this, bringing our attention to it, and bringing the entire country's
attention to it, that it won't be tolerated at the VA, and not tolerated
anywhere.

The other thing I want to say, Ms. Roof, is if Bill Kilgore were here he
would probably say hello from AMVETS, and I want to thank you for bringing that
up, the issue about the service dogs. We use service dogs to protect our troops
in foreign countries. They are out there on the front lines every day. Service
dogs are welcome in this building, in all these buildings, and they wouldn't be
welcome at a VA when they are helping a veteran. It is kind of—when you think
about it, they have helped our veterans in battle. They are welcome here in the
Capitol, in our offices, in this building, and they should be welcome when they
are assisting veterans, and so thank you for bringing that up and being
supportive.

And also, in my second term here, I really haven't taken the time to thank
the veteran service organizations for the great job you do in representing
veterans, and you do and you point out things that many times haven't been
brought to my attention. So that is all I have. I don't have any questions but
just a comment. So thank you for being here.

Ms. BUERKLE. Thank you very much. I now yield the gentleman from Missouri 5
minutes for questions.

Mr. CARNAHAN. Thank you, Madam Chairman and Ranking Member. I want to give a
special thanks to each of you representing the veterans service organizations
and the work that your organizations do on behalf of our veterans.

I also want to thank the gentleman from Texas, Mr. Carter, for being here on
behalf of his bill and pushing that.

I had wanted to ask a specific question about the bill, H.R. 198. Certainly,
it provides an assessment for addressing PTSD symptoms through the therapeutic
meaning of service dogs for veterans with disabilities, but the current
legislation only allows for, or only authorizes a pilot program. My question
is—would ask the VA to address the mental health crisis facing our Nation's
veterans, would the legislation be more successful if the bill encouraged the VA
to partner with community-based services such as Pets to Vets to better
establish a model for a large scale service dog program, would that be a
something we should look at as well to be able to scale it up faster?

Ms. ROOF. Sir, the language that—well, thank you for your support first and
foremost. The language that will be submitted to the Committee in markup
actually does address that. It does address to—to make the bill a little bit
more fiscally within our means of what we have to work with right now.
They will be partnering with private organizations.

Mr. CARNAHAN. That is great. We heard about that idea as well, and I think
using some of those existing programs that are already up and running may help
be able to get us up to a scale up that national model faster. Yes, sir.

Dr. BERGER. Mr. Carnahan, our comments really, just want to echo what I said
earlier. If you are—I don't disagree with what was just said about
public-private partnerships, but that the assessment standards that are used for
the impact of the service dogs run across the board, whether it is a VA or
public or private facility or training facility that those standards are really
important, and that they be the same. And that way, after the end of this 5-year
program, okay, we will know just how effective this is in a quantitative
fashion, and that is really important if we are talking about expanding it down
the line. We need standardized collection of data.

Mr. CARNAHAN. Great. Certainly that is helpful to us here in making decisions
going forward as well. Anybody else? If not, thank you all very much, and I
yield back.

Ms. BUERKLE. Thank you. Unless any of my colleagues have any other questions,
our second panel is finished here today. Again, thank you for your testimony.
Thank you for being here and mostly thank you for all you do on behalf of our
veterans. We truly appreciate your service and dedication. We will now ask the
third panel to join us.

Good afternoon to all of you. Representing the Department is Robert L. Jesse,
M.D., Ph.D., Principal Deputy Under Secretary for Health. Dr. Jesse is
accompanied by James M. Sullivan, Office of Asset Enterprise Management, Office
of Management; Jane Clare Joyner, Deputy Assistant General Counsel; and Charlma
Quarles, Deputy Assistant General Counsel.

Ms. BUERKLE. Dr. Jesse, please proceed, and thank you for being here this
afternoon.

STATEMENT OF ROBERT L. JESSE, M.D., PH.D., PRINCIPAL
DEPUTY UNDER SECRETARY FOR HEALTH, VETERANS HEALTH ADMINISTRATION, U.S.
DEPARTMENT OF VETERANS; ACCOMPANIED BY JAMES M. SULLIVAN, DIRECTOR, OFFICE OF
ASSET ENTERPRISE MANAGEMENT, U.S. DEPARTMENT OF VETERANS AFFAIRS; JANE CLARE
JOYNER, DEPUTY ASSISTANT GENERAL COUNSEL, OFFICE OF GENERAL COUNSEL, U.S.
DEPARTMENT OF VETERANS AFFAIRS; AND CHARLMA QUARLES, DEPUTY ASSISTANT GENERAL
COUNSEL, OFFICE OF GENERAL COUNSEL, U.S. DEPARTMENT OF VETERANS AFFAIRS

Dr. JESSE. Well, thank you very much, Chairwoman Buerkle and Ranking Member
Michaud and distinguished Members of the Subcommittee. We appreciate the
opportunity to be here today to present the Administration's views on several
bills that would affect the VA health care system, and as you just said, joining
me today are Mr. Sullivan and Ms. Joyner and Ms. Quarles.

Madam Chairman, I would like to begin by focusing on H.R. 2074, the "Veteran
Sexual Assault Prevention Act," and just to be very clear, we do agree with the
objectives as outlined in the legislation. We take the GAO report very
seriously. We are extremely concerned over the safety and security of our
veterans, our employees, and visitors, and this is among our highest priorities.
We take all allegations seriously. We investigate them thoroughly.

Last month, we told you about our efforts to improve safety and security at
our facilities, and now I would like to share with you for a moment just some of
our more recent progress.

VA's safety and security work group is developing appropriate proactive
interventions to reduce the risk of sexual assaults. We are testing our
computerized reporting system for ongoing data tracking and trending and
establishing guidance to train both staff and providers. The work group has
submitted initial action plans and there will be a final written report by
September 30, 2011. Additionally, VA is evaluating universal risks for assessing
the chance of violence and designing appropriate intervention actions. An
oversight system like the one required by the bill will be in place in VHA later
this summer, and we will have clear and consistent guidance on the management
and the treatment of sexual assaults by the end of 2011.

While we agree with many of the bill's goals, we do have several concerns.
First is the VA is committed to enhancing our safety and security policies, but
we do need time to pilot these initiatives, particularly the reporting tools,
before we can fully implement them. We believe we can have an operational system
by the end of the year, and while we recognize the urgency of the actions, we do
not want to rush and settle for what may be a second best solution.

We also have a serious concern with the bill's requirement that VA report
alcohol or substance abuse-related acts committed by veterans. VA's an
integrated health care network. We treat all of the health care needs of the
veterans, including substance use disorders and alcoholism. Reporting and
tracking these events may deter veterans from seeking care, and we do not want
to create a potential disincentive for the veterans to seek treatment, and we
recommend that this provision be deleted. We are happy to meet with the
Committee and you, Madam Chairman, to discuss these issues in more detail.

We also agree with the objectives in many of the other bills under
consideration. We are particularly pleased to support the draft capital
improvement bill. In addition to authorizing critical construction projects, the
bill will also extend VA's enhanced use lease authority, which has benefited
veterans and VA in local communities and a critical piece of the Secretary's
plan to end homelessness.

We also agree, in large part, with H.R. 1855, the "Veterans TBI
Rehabilitative Services Improvements Act." VA's primary aim for veterans
with serious or severe injuries has always been and continues to be maximizing
their independence, their health, and their quality of life. Out of these
concerns, VA has developed robust rehabilitation therapy programs to help
veterans learn or relearn skills and develop resources to sustain their
rehabilitation programs. Our primary concern with this bill was the term
"quality of life," and I was very happy to hear Mr. Walz's comments that we have
worked through those issues.

Turning to the issue of service dogs, the Subcommittee is considering a bill
to require a pilot program, which veterans with PTSD train service dogs for
other disabled veterans, and another bill would mandate VA permit veterans with
service dogs to access our facilities. For the reasons outlined in my
written statement, we believe both these bills are unnecessary because of
efforts the Department is already taking. We are happy to discuss these in more
detail.

Finally, I am pleased to report that the VA supports in principle H.R. 2530,
which would increase the flexibility in the rates of reimbursement for State
homes. VA's been working closely with State veterans home associations, and we
believe this legislation has the general support of all parties. We have noted
one minor technical amendment which we believe could further enhance our
flexibility in working with our partners at the State homes. My written
statement will discuss that issue in more detail, but I will provide any
assistance you may need on the issue.

This concludes my prepared statement. Thank you for the opportunity to
testify and be pleased to respond to any questions you may have.

Ms. BUERKLE. Thank you, Dr. Jesse, and I will yield myself 5 minutes for
questions. I am concerned about the legislation, H.R. 2074, and I would like to
ask some questions with regard to your comments.

In your testimony, you state that the timeline for the implementation of this
policy is not feasible. VA is committed to enacting this policy but needs the
time to complete work on reporting tools and processes and to pilot these
initiatives before the policy will be fully implemented. You mentioned in your
opening comment about testing a computerized reporting system.

The GAO report that came out that identified these problems was issued last
month, and it reviewed the prevalence of sexual assault and other safety issues
over the last 3 years. So it seems to me, unless the VA was completely unaware
of what was going on, that you would have had time to address these problems and
make the changes and corrections, and take care of what has been going on within
the VA system. If you could comment on that.

Dr. JESSE. Yeah, sure. So I think where we failed in this matter was
that we actually have multiple reporting mechanisms, and we at a national level
I guess had not reconciled them. So we had reporting mechanisms that were
coming up through the police side and these starting in 2009 I think as you
heard before with this stand-up of the integrating—the IOC—the integrated
operations center were coming through that side. And then we had administrative
reports coming up through VHA's line in the forms of issue briefs. And there was
a failure on our part to reconcile the two, to make sure that everything that
was coming up through issue briefs was matched up to everything that was coming
up on the police report and vice versa.

And in order to do that, it essentially required taking what was largely a
paper process, if you will, and putting in something that could be, in an
electronic fashion, reconciled, and that is the piece that is in the process of
being built now. We think we have a system that is workable, but it is—as
always, you have a million use case scenarios that have to run through this and
make sure that it is working.

Ms. BUERKLE. Well, I guess I would really caution the VA system, that time is
of the essence. We don't have time for pilots and testing when this is going on,
and it has gone on for the last 3 years. This needs to be tended to, and it
seems to me that if you are talking about duplication and just a failure to
reconcile your systems, that doesn't require you to get another system. That
just requires reconciliation so that you have complete reporting system.

Dr. JESSE. Yes, ma'am. There actually are large numbers. The system we
actually have this operating now, and we just need to make sure that it is
working in all the different scenarios that we have.

Ms. BUERKLE. Do you know what the name of the system is that will be handling
the reconciliation between the two systems?

Dr. JESSE. Well, right now, I think it is being called the data management
and tracking system.

Ms. BUERKLE. Perhaps you could provide for the Committee further information
on that tracking system.

Dr. JESSE. Sure, we would be glad to.

Ms. BUERKLE. See how that is implemented.

Dr. JESSE. Absolutely.

[The VA failed to provide information in time for printing:]

Ms. BUERKLE. The other question I wanted to ask you, if whether or not you
think this piece of legislation is perhaps duplicative or is just taking care of
issues that you are already taking care of in the VA, if you see any parts of
this bill that is unnecessary.

Dr. JESSE. Well, in some respects, the legislation very closely, I think,
follows the recommendations of the GAO, and we have already—basically, we have
concurred with the recommendations of the GAO and have started to put all of
these pieces into play.

So I guess you could say that the major objections—I mean, there is no
inherent objection to having the legislation. It actually often helps us support
what we are doing. The big concern was the timeline, and we actually think we
are going to beat that timeline, but to be held to it may force things to happen
in a fashion a little bit quicker than we would like.

And then the other piece there is, I think, a pretty significant concern
about the comments surrounding how we would be required to track and report
substance abuse issues. There is some pretty—very, I think, delicate
patient-related components of that that might through public reporting
compromise those patients.

Mr. MICHAUD. Thank you very much, Madam Chair. I want to thank you,
Dr. Jesse, and those accompanying you today.

I was reading your testimony as it relates to the State veterans homes and it
is kind of confusing. Could you explain exactly what technical concerns you have
with the bill, because my understanding is that the VA actually worked to draft
the bill or—

Dr. JESSE. Yes. And I will confess that I am not a business office person,
but I think I can explain this adequately. I think the technical concern was the
limiting term of a contract, as opposed to service provider agreements, and that
the concern was that it being specific contracts might take some of the
flexibility out of making these arrangements, and that by having service
provider agreements, it actually broadens it, and that language was vetted
through the director of the veterans homes, the national director, and I think,
my understanding is that everybody's comfortable with that language.

Mr. MICHAUD. So you are concerned because it gives the VA greater
flexibility?

Dr. JESSE. No. Actually we were concerned that by specifically saying
contract, it closed the flexibility. By using this additional term, it gives us
greater flexibility. You want to—

Ms. JOYNER. The bill that was presented is slightly different than what
appeared in the legislative proposal that was given to the Committee on June 7,
and basically it is subsection a(2) which talks about negotiating to create
rates. The concern was that it references the provider agreements, and for
provider agreements, those would be a set rate. They wouldn't be subject to
negotiation.

So the concern was in subsection a(2) by referencing the provider agreements,
that wouldn't be a viable option if we had to negotiate to do that. So the
recommendation we could work with Committee staff to explain it in more detail
would be to take out the reference to provider agreements in subsection a(2).

Mr. MICHAUD. We have been dealing with this issue for a number of years, and
that is why I am surprised that you still have a technical problem with the
legislation. So we are willing to work with the VA because I think the law is
very clear in the first place that Congress passed is that VA will pay for full
cost of nursing home care. Full cost to me means full cost. Just because the
rules and regulations VA adopted, you narrowed the full cost only for these
services, and then when you put provisions in there saying that once you receive
payment for full cost, these narrow services that VA decided to interpret
differently, and the nursing homes could not reimburse, or collect payment from
Medicare or Medicaid, that has caused a huge problem within the nursing home
facilities throughout the country.

And so hopefully we will be able to get this fixed before markup later this
week so that all parties can agree on. Because I don't think it is that
difficult.

Dr. JESSE. I actually think we are in agreement now. So it is—and we are
anxious to have this work. We are not trying to create more barriers, but I
think we are in agreement, both parties, that the language that you have now, or
you will have is acceptable and will do what needs to be done.

Mr. MICHAUD. Thank you. I have no further questions. I yield back.

Ms. BUERKLE. Thank you. I yield Mr. Carter 5 minutes for questions.

Mr. CARTER. Thank you, Madam Chairman.

I have just got a—I have got a main interest here about the service dogs and
the facilities, but I, as an old trial judge, I can't help, but have a few
questions about sexual assault.

First, I have to ask a reference because I am not aware of any previous
material. Are these touchings? Are they spoken words? Are they even worse? Do
they rise to aggravated sexual assault which is genital contact? Just exactly
what are we talking about here?

Dr. JESSE. So if you—and I know this was an interest to the Committee. If you
look in the current time period from when the GAO report ended until last week,
there is little—141 reports of sexual assault. So of those, six were alleged
rape, of which two were substantiated; 78 were inappropriate touching, of which
31 were substantiated; and then the other were, others, and there is a number of
things that that could be. It could be public nudity, things along those lines,
and this is actually one of the real issues here is what is the definition of
sexual assault, and OIG has a different definition than GAO, and one of the
Committees that has been working on this is that is to actually come up with the
definition that makes sense in our environment and that seems to be moving
towards the GAO definition.

Now, it is interesting because that, I think, specifically excludes, if I
remember this correctly, sexual discrimination as opposed to the more physical
things, but it is—remembering that in our environment, we are often dealing with
very sick people. We are often dealing with people who are disoriented, even
people who aren't disoriented and come into a hospital and they can, they lose
when they are out of touch of their own surroundings or when they are getting
different medications, can become disoriented. And they do things and things
happen that they wouldn't do normally and the real important part for us is to
make sure that, first of all, people are protected.

People aren't armed and that we can understand what these terms really mean.
So from the judge's perspective, actually having a definition to work off
becomes, I think, a crucial first step forward.

Mr. CARTER. There are plenty of definitions in the law books.

Dr. JESSE. Well, that is the problem, there are plenty of definitions, then
you have to be able to work off one of them.

Mr. CARTER. First off, I assume everybody in this room would assume that in
the scope of the terrible things that happen to people in the world, sexual
assault is right at the top of the list, or pretty close to it, murders may be
above it. At least in the courthouse of most the States that I know about, we
consider aggravated sexual assault to be one of the very serious things, and in
my particular county, everyone that has been convicted of aggravated sexual
assault will be in the penitentiary for at least 60 years. So we take that very
seriously and that is a curtailment for people.

Doctors have a duty to report what they assume to have been aggravated sexual
assault. Do you report this to the authorities? And I understand there are
mitigating circumstances and those delusions or whether people are, you know,
taking some kind of medicine or something. That may be an extenuating
circumstance, but sexual assault shouldn't be tolerated in any form or fashion
by any institution in this country.

Dr. JESSE. No, we agree fully, and we do have requirements which will be
reiterated, which we will re-educate everybody on about the requirements for
reporting.

Mr. CARTER. Well, not just reporting, but if necessary put them—turn them
over to the district attorney.

Dr. JESSE. Oh absolutely.

Mr. CARTER. One or two of those might break a lot of folks of some bad
habits.

You said you were concerned about—I am going to ask about my dog bill right
quick. The vet dogs you say are handled by regulation and I do appreciate. Let
me say that when that issue was raised, we do thank you for handling it by
regulation. However, it was along—you don't think that this complicates, in any
way, that regulation if we were to make this—actually pass this bill into law?
You just take the position it is unnecessary; is that correct?

Dr. JESSE. In terms of access?

Mr. CARTER. Yes.

Dr. JESSE. So we, I think, were not clear about what the VA policy was, which
is, I think, what has created the problem. The directive that was put out
earlier this year makes that policy very clear, and I don't think the
legislation adds anything to that policy. Again, it is incumbent on our part to
make sure—

Mr. CARTER. Could at least I make an argument what it adds to the policy is
surety?

Dr. JESSE. Excuse me.

Mr. CARTER. What it adds to the policy is surety. You are sure you have this
right now because it is a law, whereas before, regulations change by regulators,
and they can change with the wind. And so it is much more a right of a soldier—I
use soldiers because I have nothing but soldiers in my district just about—but
warriors. Warrior has a right to have that dog with them if we pass this and
make it law. It is at the whim of the regulators otherwise, and I would argue
that at least is a good reason why we should go forward.

Dr. JESSE. Well, as I said, we believe strongly what you believe and we have
the regulation in place now.

I guess I wanted to follow up on Mr. Carter's questions about the service dog
legislation. You said it was not necessary because of steps the VA is taking
internally and I want to be sure I understand it. Are those steps you believe
have already been taken, or they are in the process?

Dr. JESSE. Oh, yes, sir. There is a directive—well, it is 2011-13, which
means it was put out probably in late January or early February, that very
clearly articulates that veterans with service dogs have access to all VA
facilities.

Mr. CARNAHAN. And it is your belief that based on that, the legislation is
not necessary?

Dr. JESSE. Well, except in the context that Mr. Carter said that it puts it
into law versus regulation, but as I say, we have the regulation in place
already, and we would—it is incumbent on us now to ensure every person and every
VA understands that this is the requirement.

Mr. CARNAHAN. I think that is certainly an important step in the process, but
I certainly want to go on record again strongly supportive of Mr. Carter's
legislation to get that put into law.

Also, switch to another topic. In reviewing the legislation before us today,
the draft legislation on the "Veterans Health Care Capital Facilities
Improvement Act," some funding in there is especially important to the St. Louis
region of the Jefferson Barracks Medical Center. They have, as you know,
it is really a win-win there, because the medical center has conveyed 33 acres
to the National Cemetery that was running out of space, and so that is going to
be a big boost to the National Cemetery there. It has been a big demand from
veterans in our region, but also this funding for these new buildings is going
to help the medical care at that facility.

So we think that is highly important for veterans in the region. One of the
things related to those buildings, and we have had this come up in several
discussions with regard to our government buildings, is the extent to which they
are going to be designed to be more energy efficient and more green design. We
have seen pretty dramatically the effect even though there may be a little bit
more up-front cost by building these buildings more efficiently. Normally, the
pay-back period is 3 to 5 years on that improved technology in design of the
buildings, so we have some really long-term savings involved from operating
those buildings. To what extent is that going to be incorporated into these
buildings at the VA center there?

Mr. SULLIVAN. Good afternoon. In the 2012 budget, there is $80 million
requested for the portion of the project in St. Louis that you refer to, as well
as an updated authorization request included in this bill. That phase of the
funding is for the site utility work and the energy plant, which will
incorporate the latest requirements for greening in terms of renewable energy,
as well as the latest standards for building to energy efficiency standards.
These standards are included in this project, as well as all VA projects that go
forward.

Mr. CARNAHAN. Great. Again, thank you for your work on that and just want to
really reiterate what a real win-win that is for the VA Medical Center in St.
Louis, and for our National Cemetery. Thank you. I yield back.

Ms. BUERKLE. Thank you. I believe the Ranking Member has one follow-up
question so I yield 5 minutes to him.

Mr. MICHAUD. Thank you, Madam Chair. Actually, this is for Judge
Carter. As you heard Dr. Jesse mention, when you look at the definition of
aggravated sexual assault, if each State might have a different definition, one
of the concerns that we have as a Committee is how you train VA employees to
deal with it? And with different definitions by different States, and when you
have directors moving from one State probably to another State, they might have
a different definition. I hope with your expertise, that you might be able to
help us how we can deal with this and make it easier as well for the VA system.

Mr. CARTER. Well, it has been a while since I have been in the rewriting of
some of the laws, but I can tell you that most of the States now have adopted a
sort of uniform definition of aggravated sexual assault and lesser degrees of
sexual assault, and the reason I say most of them, some States still use
the—some would argue non-legal description called "rape" and "statutory rape,"
and of course, colloquially we still use those terms, but most States I think,
there is plenty of studies that will tell you exactly what they have done to
make their changes. But that has been involved now over the last 30 years, and I
would venture a guess that you would find that most of the sexual assault
definitions that you find in the law are very, very similar, at least, first
cousins.

The concepts were all the same, words were slightly different. So you can get
a pretty good guidance from any penal code of any State, what overall it is
across the country. Maybe with a few exceptions and that is where I would start.
I would start getting somebody to just check and see how uniform the penal codes
are. I am sure there is somebody that can give you that information very
quickly.

Mr. MICHAUD. Thank you very much.

Mr. CARTER. If you can't get it, I can find it. I can get somebody who can
get it for you. Just holler at me.

Mr. MICHAUD. Thank you. Thanks again, Madam Chair.

Ms. BUERKLE. Thank you. I yield myself just a couple of minutes. I have
a couple of follow-up questions.

First of all, you are going to submit to us the data processing and the
system you are going to use in and the timeline and how that will work. Could
you also provide to us how the VA has complied with the GAO report, what pieces
of their recommendations have you put in place, and what pieces remain
outstanding and what progress you have made with regards to their
recommendations.

Dr. JESSE. Absolutely.

[The VA subsequently provided the update on the actions taken by VA in
response to the eight GAO recommendations, with a letter and enclosures, dated
August 5, 2011, from John R. Gingrich, Chief of Staff, U.S. Department of
Veterans Affairs, to Randall Williamson, Director, Health Care, U.S. Government
Accountability Office, which appears in the Appendix.]

Ms. BUERKLE. Okay. Very good. Thank you. I do want to comment on something
you said because I think it bears commenting on, and that is, you said that you
know the definition of sexual assault may be a problem to reach that conclusion
because you have to have a definition that makes sense relative to the
environment within the VA, that there are very sick people, very disoriented
people.

I would argue that the levels of illness and issues that the patients have
within the VA system would raise the bar for the VA system, but sexual assaults
are sexual assaults, and that only means that the VA system has to—work harder,
be more effective and be much more aware of what is going on within VA
facilities. It doesn't change what sexual assault is. It doesn't change the
outcomes, but it requires more and it raises the bar for the VA system.

Dr. JESSE. Absolutely. It is a terrible problem, and we are taking this very
much to heart. We agree.

Ms. BUERKLE. And with that, and if there are no further questions I move the
Members have 5 legislative days to revise and extend their remarks and include
extraneous material. Without objection, so ordered.

Once again, Dr. Jesse and to the entire panel our sincere thanks for you
coming here today and answering our questions. To all of our audience, thank you
for your participation. To the veterans in this room, thank you all for your
service to this Nation. We are deeply appreciative of what you have done for our
country, and you have preserved and protected our freedoms, so thank you for
your service to this Nation.

This hearing represents an important step in the legislative process and, as
such, I look forward to a frank and productive conversation about the policy
implications, merits, and potential unintended consequences of each of the
proposals on our agenda.

One of the bills we will discuss this afternoon is H.R. 2074, the Veterans
Sexual Assault Prevention Act, a bill I introduced in response to a truly
alarming report issued last month by the Government Accountability Office (GAO)
on the prevalence of sexual assault and other safety incidents in VA facilities.
I am pleased to sponsor this legislation with our Chairman, Jeff Miller, and
with Ranking Members, Bob Filner and Mike Michaud as co-sponsors.

In their report, GAO found that between January 2007 and July 2010 nearly 300
sexual assaults, including 67 alleged rapes, were reported to VA police.

Troublingly, and in direct violation of Federal regulations and VA policy,
many of these incidents were not properly reported to VA leadership officials or
the VA Office of the Inspector General.

As disturbing, GAO uncovered serious deficiencies in the guidance and
oversight provided by VA leadership officials on the reporting, management, and
tracking of sexual assault and other safety incidents.

GAO also found that the Department failed to accurately assess risk or take
effective precautionary measures, with inadequate monitoring of surveillance
systems and malfunctioning or failing panic alarms.

As a domestic violence counselor, I have seen firsthand the pervasive and
damaging effects sexual assault can have on the lives of those who experience
it.

Abusive behavior like the kind documented by GAO is unacceptable in any form,
but for it to be found in what should be an environment of caring for our
honored veterans is simply intolerable.

Specifically, H.R. 2074 would require VA to develop clear and comprehensive
criteria with respect to the reporting of sexual assault and other safety
incidents for both clinical and law enforcement personnel.

It would establish a newly accountable oversight system within the Veterans
Health Administration (VHA) to include a centralized and comprehensive policy on
reporting and tracking sexual assault incidents, covering all alleged or
suspected forms of abusive or unsafe acts, as well as the systematic monitoring
of reported incidents to ensure each case is fully investigated and victims
receive appropriate treatment.

To correct serious weaknesses observed in the physical security of VA medical
facilities and improve the Department’s ability to appropriately assess risk and
take the proper preventative steps, H.R. 2074 would mandate the Department to
develop risk assessment tools, create a mandatory safety awareness and
preparedness training program for employees, and establish physical security
precautions including appropriate surveillance and panic alarm systems that are
operable and regularly tested.

It is critically important that we take every available step to protect the
personal safety and well-being of the veterans who seek care through the VA and
all of the hardworking employees who strive to provide that care on a daily
basis.

I am eager to discuss H.R. 2074 this afternoon and am here to answer any
questions my colleagues may have about this legislation.

Also on our agenda today is a draft Committee proposal, the "Veterans Health
Care Capital Facilities Improvement Act of 2011." This draft legislation
incorporates the Administration’s fiscal year 2012 construction request to
authorize major medical facility projects and leases. The draft proposal also
modifies the statutory requirements for the Department to provide a prospectus
to Congress when seeking authorization for a major medical facility project to
ensure we receive a comprehensive and accurate cost-benefit analysis as the
basis for making these critical decisions.

It also extends authorities to provide for important programs related to such
initiatives as housing assistance for homeless veterans and treatment and
rehabilitation for veterans with serious mental illness, both of which are set
to expire at the end of this calendar year.

Additionally, section six of the draft bill seeks to provide an extension of
VA’s enhanced use lease authority which is also set to expire this year. This
authority is an innovative and vitally important approach to supporting goals we
all share, such as reducing homelessness among the veteran population and making
effective use of vacant or underutilized VA property, through public-private
partnerships. Unfortunately, the Congressional Budget Office has scored this
provision with a mandatory spending cost of $700 million. We want to work with
the Department and the veterans service organizations to resolve this scoring
issue to ensure that VA has the authority to continue utilizing this important
program.

The draft bill also includes legislation that was brought to us by our
colleague from Colorado, Mr. Scott Tipton, to designate the telehealth clinic in
Craig, Colorado as the “Major William Edward Adams Department of Veterans
Affairs Clinic.” Major William Edward Adams is a Medal of Honor recipient and
Scott has provided a statement for the record detailing Major Adam’s courageous
service to our country.

I want to thank all of the Members who sponsored the bills and draft
legislation before us, as well as the witnesses from the veterans services
organizations and the Department, for taking time out of their busy schedules to
share their expertise with us this afternoon. I look forward to our discussion
and will now yield to the Ranking Member, Mr. Michaud for any opening statement
he may have.

Today’s legislative hearing is an opportunity for Members of Congress,
veterans, the VA and other interested parties to provide their views on and to
discuss introduced legislation within the Subcommittee’s jurisdiction in a clear
and orderly process.

We have seven bills before us today which address a number of important
issues for our veterans and provide the staff of the Department of Veterans
Affairs with the necessary tools to provide the best care for our veterans.
First, we have two bills to help veterans with post-deployment mental health
issues through training service dogs. The remainder of the legislation covers a
wide range of topics, such as improved TBI care, sexual assault prevention,
facilities construction, and Spina Bifida.

We will also examine my bill, H.R. 2530, which seeks to increase flexibility
in payments for State Veterans Homes. It would require State Veterans Homes and
the VA to enter into a contract for the purpose of providing nursing home care
to veterans who need such care for a service-connected condition or have a
service-connected rating of 70 percent or greater.

I look forward to hearing the views of our witnesses on the bills before us
today.

Madam Chair, I yield back.

Prepared Statement of Michael G.
Grimm, a Representative in Congress from the State of New York

Chairman Buerkle, Ranking Member Michaud, thank you for allowing me to
testify today on H.R. 198, the “Veterans Dog Training Therapy Act.” As a Marine
Combat Veteran of Operation Desert Storm it is a unique honor for me to address
this Committee. Having seen firsthand both the physical and mental wounds of war
that the members of our nation’s military are faced with, I have a special
appreciation for the important work this Committee does every day.

Today, over 2 million Iraq and Afghanistan Veterans have returned home to the
challenge of an unemployment rate hovering near 10 percent, which for disabled
veterans is actually closer to 20 percent, and, for many, the long road to
recovery from the mental and physical wounds sustained during their service.
Sadly, these numbers continue rising every day.

Over the last 6 months I have had the honor to meet with a number of our
nation’s veterans who are now faced with the challenges of coping with PTSD and
physical disabilities resulting from their service in Iraq and Afghanistan.
Their stories are not for the weak of heart and are truly moving. It was these
personal accounts of their recovery, both physical and mental, and the important
role therapy and service dogs played, that inspired this legislation.

The Veterans Dog Training Therapy Act would require the Department of
Veterans Affairs to conduct a 5-year pilot program in at least three but not
more than five VA medical centers assessing the effectiveness of addressing
post-deployment mental health and PTSD through the therapeutic medium of
training service dogs for veterans with disabilities. These trained service dogs
are then given to physically disabled veterans to help them with their daily
activities. Simply put, this program treats veterans suffering from PTSD while
at the same time aiding those suffering from physical disabilities. Since I
introduced this legislation it has gained the bipartisan support of 83
cosponsors, including Financial Services Committee Chairman Spencer Bachus and
Ranking Member Barney Frank as well as Congressmen Pete Sessions and Steve
Israel. Clearly, this legislation has brought together a number of unlikely
allies in support of our nation’s veterans.

Additionally, with veteran suicide rates at an all time high and more
servicemen and women being diagnosed with PTSD, this bill meets a crucial need
for additional treatment methods. I believe that by caring for our nation’s
veterans suffering from the hidden wounds of PTSD while at the same time
providing assistance dogs to those with physical disabilities we create a
win-win for everyone, which I believe is a goal we can all be proud to
accomplish.

Working in conjunction with a number of Veteran Service Organizations,
including AMVETS and VetsFirst, I have drafted updated language which I intend
to have submitted during Committee markup of H.R. 198 to ensure this program
provides our nations veterans with the highest quality care for both PTSD and
physical disabilities, while maintaining my commitment to fiscal responsibility.

I understand that in the current economic situation we are faced with it is
especially important to ensure taxpayer dollars are spent wisely, which is why I
have identified several possible offsets, to include shifting funds from the
Veterans Affairs General Administrative Account, to make sure this legislation
meets pay-go requirements. As we move forward in the legislative process I look
forward to working with the Committee to ensure that any money allocated for
this program is offset by reductions in other accounts.

Again, I would like to thank the Committee for holding today’s hearing and I
look forward to working with you to ensure that this program is included in your
continuing efforts to guarantee that our nation’s heroes have the best possible
programs for treating PTSD and providing disability assistance.

Prepared Statement of Hon.
Timothy J. Walz, a Representative in Congress from the State of Minnesota

I want to thank Chairwoman Buerkle, Ranking Member Michaud, and Members of
the Subcommittee for giving me the opportunity to appear before you today to
discuss my bill, HR 1855, the Traumatic Brain Injury Rehabilitative Services
Improvements Act of 2011.

It is a deep privilege to be a Member of a Committee devoted to serving those
who have served our country. We are truly the stewards of a grateful nation
that recognizes our obligation to America’s servicemen and women.

We are also Members of a Committee with a great history – not only of
developing landmark legislation to meet the needs of many generations of
veterans, but of doing this important work on a bipartisan basis. The
Committee’s rich legacy continues to the present.

Reflecting on the needs of many of those veterans, I introduced legislation
late last year, together with Chairman Miller and Congressman Bilirakis, to help
some of our most severely injured, those with traumatic brain injury. That
legislation was aimed at improving the rehabilitative services that are so
important to these young men and women.

Having re-introduced the bill earlier this year, I’m particularly
appreciative that the Subcommittee has included it on the agenda.

Unprecedented numbers of warriors are returning home from Iraq and
Afghanistan with severe polytraumatic injuries. This is not only due to the
nature of the fighting and the kinds of injuries being sustained, but to
advances in military medicine and logistics that have saved countless lives that
might have been lost in previous wars.

Traumatic brain injuries are among the most complex injuries our personnel
have sustained. Each case is unique and injuries can result in wide-ranging loss
of function. Neurological and cognitive loss or impairment in speech, vision,
and memory, for example, are not uncommon – as is marked behavioral change, with
such manifestations as impaired judgment or diminished capacity for
self-regulation.

It is difficult to predict the extent of an individual’s ultimate level of
recovery, but the evidence is clear that to be effective in helping an
individual recover from a brain injury and return to a life as independent and
productive as possible, rehabilitation must be targeted to the specific needs of
the individual patient.

H.R. 1855, the Traumatic Brain Injury Rehabilitative Services Improvements
Act of 2011, is aimed at closing gaps in current law that have had the effect of
denying some veterans with severe TBI from achieving optimal outcomes.

Many VA facilities have dedicated rehabilitation-medicine staff, but the
scope of services actually provided to veterans with a severe TBI can
be limited, both in duration and in the range of services authorized. Veterans
encounter two distinct problems.
First, it is all too common for staff to advise families that the VA can
no longer provide a particular rehabilitative service because the veteran is no
longer making significant progress. But ongoing rehabilitation is often
needed to maintain
function, and individuals who are denied maintenance therapy can regress and
lose cognitive and other gains they’ve made through rehab work.

A second problem veterans encounter is in getting help with community
reintegration, and learning to live as independently as possible. VA’s
rehabilitation focus relies almost exclusively on a medical model; that
assistance is critical, but doesn’t necessarily go far enough for some veterans
in providing the range of supports a young person needs to achieve the fullest
possible life in the community.

In contrast, other models of rehabilitative care meet TBI patients’ needs
through such services as life-skills coaching, supported employment, and
community reintegration therapy. These services are seldom made available
to veterans. Yet research has shown that with these types of innovative
non-medical supports, individuals with severe TBI can flourish in a community
setting. Denying wounded warriors such supports compromises their achieving the
fullest possible recovery.

H.R. 1855 would close these gaps. Specifically, it would clarify that VA may
not prematurely cut off needed rehabilitation services for an individual with
traumatic brain injury, and that veterans with TBI can get the supports they
need – whether those are health-services or non-medical assistance -- to achieve
maximum independence and quality of life.

I’m gratified by the broad support the bill has won from major veterans’
service organizations. And I’m particularly pleased at the strong endorsement
from Wounded Warrior Project, whose Executive Director, Steve Nardizzi,
described the bill as “powerfully addressing the often agonizing experience of
wounded warriors who have been denied important community-reintegration supports
and who have experienced premature termination of rehabilitation services.” As
Steve said, “This bill offers new hope to these warriors and their families.”

I look forward to responding to all of your questions, and with that, I yield
back my time.

Prepared Statement of Hon.
Larry Bucshon, a Representative in Congress from the State of Indiana

Thank you Chairwoman Buerkle, Ranking Member Michaud, Members of the
Subcommittee, for the opportunity to come and speak to you today about my draft
legislation, the Honey Sue Newby Spina Bifida Attendant Care Act.

In April of this year, I was contacted by a constituent from New Harmony, Mr.
Ron Nesler, on behalf of his step daughter, Honey Sue Newby. Honey Sue’s father
was a Vietnam Veteran exposed to Agent Orange; and she was born with a
complicated neurological disorder rooted in Spina Bifida, a congenital
condition in which the vertebrae do not form properly around the spinal cord.
The Veterans Administration has previously determined Honey Sue’s condition is a
direct result of her father’s exposure to Agent Orange in Vietnam and have
classified her as a Level III child, making her eligible to receive the same
full health care coverage as a veteran with 100 percent service-connected
disability.

In 2007, Mr. Nesler and his wife reached out to my predecessor, former-
Representative Brad Ellsworth regarding two issues they had been experiencing
with the VA. The first was an administrative burden requiring a letter from
Honey Sue’s doctor explaining exactly how the treatment she sought was related
to her Spina Bifida. More often than not, this resulted in the VA denying
repayment until additional burdensome administrative procedures took place. For
example, Honey Sue needed surgery on her mouth after seizures caused her to
grind her teeth to nubs. The VA originally denied payments for the procedure
saying the doctor’s letter did not clearly make the case that this result was
related to the condition.

Secondly, Honey Sue’s parents are aging and experiencing health problems.
Currently, the only long term services the VA will pay for is nursing home care
for individuals like Honey Sue. Nursing home care is both extremely expensive
and inappropriate for what Honey Sue needs. Individuals with Spina Bifida have a
diverse range of needs. Although no two cases of Spina Bifida are ever the same,
the National Spina Bifida Association confirms the majority of these individuals
can live independently if they have the proper habilitative care in order to
develop, maintain or restore their functioning.

Former Rep. Ellsworth’s bill, H.R. 5729, was written to address both of these
issues and on May 20, 2008 H.R. 5729 was passed by voice vote in the House of
Representatives and was later added to S. 2162, the Veterans Mental Health and
Other Care Improvement Act of 2008. This legislation was signed by President
Bush on October 10, 2008 (Public Law 110-387).

Since then, the VA has recognized and alleviated the administrative burdens,
but has not properly interpreted ‘habilitative care’. Title 38 of the U.S. Code
defines habilitative care as ‘professional, counseling, and guidance services
and treatment programs (other than vocational training under section 1804 of
this title) as are necessary to develop, maintain, or restore, to the maximum
extent practicable, the functioning of a disabled person.’ Under this language,
I believe the VA is misinterpreting the law and its intent as it concerns
individuals with type III Spina Bifida who simply need supervisory, or as we put
it in the draft legislation- home and community based-care.

The purpose of this draft legislation is to clarify Title 38 to allow
individuals with Spina Bifida the appropriate and cost effective care they
deserve. The intended result allows individuals to take advantage of home and
community based care for those that do not need constant medical care. The term
‘Home and community based care’ is used in the definition of ‘habilitative care’
in section 1915 of the Social Security Act and this legislation is modeled after
and aims to create consistency for that definition within VA services.s.

Again, thank you for the consideration of this legislation. I am happy to
answer any questions.

Prepared Statement of Hon. John
R. Carter, a Representative in Congress from the State of Texas

Thank you Chairwoman Buerkle, Ranking Member Michaud, and distinguished
Members of the Subcommittee. I am here today to discuss H.R. 1154, the Veterans
Equal Treatment for Service Dogs (VETS Dogs) Bill, which I introduced on March
17, 2011. This bi-partisan bill has gained widespread support, with over 60
Cosponsors to date.

The VETS Dogs Bill is quite simple and does not cost any money; it merely
ensures that Veterans with medical service dogs have equal access to all
Veterans Affairs (VA) facilities. Currently, only seeing-eye and guide dogs are
allowed access. This bill was first brought to my attention by the American
Veterans (AMVETS) organization, and is supported by the Veterans of Foreign Wars
(VFW), Military Order of the Purple Heart (MOPH), VetsFirst, and Paws with a
Cause. Additionally, this bill complies with the Americans with Disabilities Act
(ADA) as well as the Rehabilitation Act.

The VETS Dogs Bill recognizes that medical service dogs are used increasingly
more for treatment and assistance of medical issues other than blindness. For
example, Veterans currently use medical service dogs for support in cases of
Traumatic Brain Injuries (TBI), hearing loss, seizures, as well as for mobility
assistance. With this increased usage, it is crucial that we help these Veterans
and their service dogs gain access to all VA facilities.s.

The VA issued a directive in March 2011 requiring the Veterans Health
Administration (VHA) to allow medical service dogs into its facilities. While
this is a very positive step for the VA, this directive does not apply to all VA
facilities and expires in 2016. The VETS Dogs Bill will assist the VA in
solidifying this directive through including all VA facilities and by making
such access permanent law. I applaud the VA for continuing to make great strides
to improve care provided to all wounded Veterans. This bill simply closes the
gap in access that currently exists.

I would like to recognize Deb Davis from Paws with a Cause, who is here with
her dog Krickit today. Deb helped to write this important piece of legislation.
Additionally, Kevin Stone and his dog Mambo are also in attendance today. Mambo
assists Kevin with mobility, and serves as a great example of how medical
service dogs can help wounded Veterans. Kevin believes that Mambo has allowed
him to regain his independence and quality of life. However, Kevin has
been denied access to VA Medical Centers (VAMC) since Mambo is not a seeing-eye
or guide dog. We are failing Kevin and other wounded Veterans if we allow this
to keep happening. Madame Chairwoman and Committee Members, thank you for giving
me the opportunity to speak today on the Veterans Equal Treatment for Service
Dogs (VETS Dogs) Bill.

U.S. Representative John R. Carter was elected in 2010 to his fifth term
representing Texas' Thirty-First Congressional District in the U.S. House of
Representatives. Since his first election in 2002, Congressman Carter has
established himself as a leader in Congress who has the foresight and courage to
author and support numerous pieces of legislation that would increase the
protection of U.S. citizens and bring justice to those who threaten our freedom
and way of life.

Congressman Carter was also unanimously re-elected in 2010 to a third term as
House Republican Conference Secretary. In this position, Congressman
Carter is the sixth highest-Ranking Republican in the House.

He has served on the prestigious House Appropriations Committee since 2004,
and currently sits on the Transportation, Homeland Security, and Military
Quality of Life and Veterans Affairs Subcommittees. During the 108th
Congress, Congressman Carter was a Member of the House Education and the
Workforce, Judiciary, and Government Reform Committees.

Carter also continues to serve on the House Republican Steering Committee, an
official group of members who are in charge of placing Members on Committees.
Carter has been honored to serve on this select panel since being elected to
Congress.

Congressman Carter's leadership ability has been recognized by his colleagues
and others. During his first term, Congressman Carter was named one of the "Top
Five Freshman" in Congress by Capitol Hill's leading newspaper.

For Congressman Carter, leadership goes far beyond the Committee room and
onto the House floor, where he has successfully had legislation passed and
signed into law under both Presidents Bush and Obama. Bringing to Congress 20
years of judicial experience, Congressman Carter has consistently worked to
advance a tough on crime agenda.

In July 2004, President Bush held a signing ceremony for Congressman Carter's
Identity Theft bill at the White House. The law lessens the burden of
proof making identity theft easier to prove and prosecute and also defines and
creates punishment for aggravated identity theft.

Congressman Carter bears the nickname of "Judge" on Capitol Hill and at home
for serving over 20 years on the bench. In 1981, Congressman Carter was
appointed the Judge of the 277th District Court of Williamson County and was
elected District Judge in 1982. Before becoming a Judge, Congressman Carter had
a successful private law practice and continued to practice law while serving as
the Municipal Judge in Round Rock. He was the first county-wide elected
Republican in Williamson County history. As an attorney, Carter represented the
Round Rock and Williamson County communities through their first booming phases
of growth and continues to support and guide today's growth. Congressman Carter
has seen the economy both rise and fall and has a plan to assist the residents
in Congressional District 31 to ensure their prosperity.

A true Texan at heart, Congressman Carter was born and raised in Houston and
has spent his adult life in Central Texas. Carter attended Texas Tech University
where he graduated with a degree in History and then graduated from the
University of Texas Law School in 1969. Congressman Carter and his wife, Erika,
met in Holland and have been happily married since June 15, 1968. Since then
they have built a home and raised a family of four on Christian beliefs and
strong Texas Values.

Prepared Statement of Shane
Barker, Senior Legislative Associate, National Legislative Service, Veterans of
Foreign Wars of the United States

MADAM CHAIRWOMAN AND MEMBERS OF THIS COMMITTEE:

On behalf of the 2.1 million members of the Veterans of Foreign Wars of the
United States and our Auxiliaries, the VFW would like to thank this Committee
for the opportunity to present its views on these bills.

H.R. 198, Veterans Dog Training Therapy Act

The VFW appreciates the intent behind this bill. However, we do not believe a
VA medical center is the right environment for a pilot program involving
dog-training. We believe the idea behind this legislation – to help veterans
with post-traumatic stress disorder by incorporating a therapeutic dog training
class as a part of their treatment – would be better achieved through
established private sector organizations with sufficient oversight by VA.
Partnering with outside entities that have experience and proven success in this
area would provide the veteran with the outcomes this bill wants to evaluate. It
would also localize the program by moving it from VA medical centers to the
communities where many of our veterans live. Overall, we think such changes
would achieve greater results with no further cost to VA, and with fewer
complications for our veterans.

H.R. 1154, Veterans Equal Treatment for Service Dogs Act

The use of medical service dogs among veterans is increasing, and many of our
newest veterans who are returning home from war with mental and physical
disabilities have a particular need for their services. We believe that trained
dogs play a significant role in helping to provide independence to individuals
with a broad range of disabilities.

Currently, VA allows seeing-eye dogs to enter medical facilities without
limitations. Senator Harkin’s legislation would allow all service dogs into
facilities that receive VA funding. The VFW is happy to lend our support to a
benefit that is often overlooked and can go a long way towards helping an
individual with a disability who may not be able to perform a task
independently.

The VFW supports this legislation to expand and improve the plan for
rehabilitation and reintegration of TBI patients. This legislation would require
VA to broaden their TBI treatment plans to focus on an injured veteran’s
independence and quality of life while making improvements to their behavioral
and mental health functioning. We know that VA is working to do more than merely
stabilize these men and women, but we are fully supportive of adding language to
the United States Code that requires VA to pursue treatment options that would
improve their functioning.

It expands the scope of rehabilitative service for veterans suffering from
brain injury to include behavioral and mental health concerns. As a result of
this bill, the phrase “rehabilitative services” replaces the word “treatment” in
pertinent areas of the United States Code, thereby conforming it to the
prevailing wisdom that TBI patients deserve more than mere treatment of their
injuries. This change is critical because these men and women deserve ongoing
evaluation and additional intervention where necessary to ensure a full
recovery. We believe the changes in this bill would make it easier for veterans
struggling with the aftermath of a TBI to receive such coverage. Finally, this
bill would also support TBI patients by associating sections of the law related
to TBI rehabilitation and community reintegration to a broader definition of the
term “rehabilitative services” that comprises a range of services such as
professional counseling and guidance services. This bill would help to ensure
our response to traumatic brain injuries consists of more than just healing the
wounds that we can see. Our veterans deserve every chance to lead productive
lives, which is why the VFW believes that VA and U.S. Department of Defense
(DoD) should look into any and all potential rehabilitation and treatment models
for veterans who suffer from TBI.

H.R. 2074, Veterans Sexual Assault Prevention Act

We thank Health Subcommittee Chairwoman Buerkle and Chairman Miller for
introducing H.R. 2074, the “Veterans Sexual Assault Prevention Act,” and we are
pleased to see this Committee continuing to work diligently on this critical
issue. As we have said before, one incident of assault, of a sexual nature or
otherwise, is one too many. The VFW reaffirms, in no uncertain terms, the need
for a zero-tolerance policy. Less than that is unacceptable and inexcusable.
Veterans should never have to visit a VA medical facility with concerns about
their personal safety.

We want the guilty punished, but we also strongly believe that any
legislation signed into law should ensure exonerated employees are not adversely
affected. VA must be extremely judicious not to allow unsubstantiated
allegations to bring about negative consequences for the accused, while at the
same time holding the guilty accountable for such heinous actions. The VFW does
not want to see dedicated employees leave the VA system for this reason, so any
successful cultural change within VA must include protections for innocent
employees wrongfully accused.

The most important missing piece is a comprehensive, continuous, and
evidence-based training program. All efforts to properly identify sexual assault
and to create programs to forward allegations to appropriate officials are in
vain if employees are not trained to be vigilant and to identify problem
situations. We strongly believe that VA must institute a first-class
training program that is mandatory for all VA employees to attend.

They must also clarify what constitutes sexual assault, because the lack of a
clear and consistent VA-wide definition has allegedly led to many events not
being reported, or resulted in no action on those events that were reported. GAO
also recommended VA police create a system-wide process that would result in
cases involving potential felonies to be automatically reported to the VA Office
of the Inspector General. Frankly, we are shocked that such a common-sense
Standard Operating Procedure does not already exist.

VA leadership has failed in their obligations for too long, and the hidden
nature of this unacceptable problem requires Congress to act quickly. We stand
ready to assist the Committee in passing this legislation without delay.

H.R. 2530, a bill to amend title 38, United States Code, to provide for
increased flexibility in establishing rates for reimbursement for State homes by
the Secretary of Veterans Affairs for nursing home care provided to veterans.

The VFW supports this straightforward legislation to eliminate the rigid
system currently in place to reimburse State homes for nursing home care
provided to veterans. The current reimbursement system pays State homes
uniformly across the country, without taking into account costs of living or
costs of goods and services from State to State. These costs vary considerably,
and the result of the uniform payment schedule results in some States doing
well, and other States not being able to provide needed services without some
significant negative financial impact.

The services State veterans homes provide are critical, and they are not
looking for disproportional profits. They are looking to sustain themselves, and
we strongly believe that VA must be a partner in that effort. This legislation
would help achieve that by allowing VA to enter into contracts with individual
State veterans homes for payment schedules that are crafted in consultation with
the State home. This change will make these payments more equitable and
sustainable for everyone involved, and this bill has broad stakeholder support.
We strongly believe that it will put these complications to rest, and will work
to bring about its passage into law.

The VFW supports this measure to give VA the authority to provide more
appropriate care for Honey Sue Newby, and other children of Vietnam veterans
suffering from Spina Bifida. The story of Newby is a harrowing tale of VA – for
whatever reason – being counterproductive in providing care at every turn. It is
also a story of perseverance on the part of this family to find the care that
Honey Sue desperately needed. That provision of care was granted by Congress and
earned by virtue of Mr. Newby’s service. However, the record is clear that they
have suffered time and time again due to onerous VA requirements.

This bill will make it easier for family attendants to persevere through VA
requirements as they care for a child with Spina Bifida by broadening the types
of care VA can provide, and will allow VA to enter into contracts with providers
who offer enhanced and new types of care. It expands outpatient care to include
adult day health services. Perhaps most importantly, it expands home care to
help offset having a live-in, unrelated personal caregiver in cases where not
having one would result in admission to a hospital, a nursing care facility, or
an intermediate care facility.

These changes will greatly improve the quality of life for families of
veterans exposed to Agent Orange who have children who suffer from Spina Bifida.
We strongly support this legislation and look forward to working with you to get
it enacted.

The Veterans Health Care Facilities Capital Improvements Act of 2011 is
necessary in building and utilizing VA properties in a way that will provide
greater quality and access to care for veterans. The authorization of funds for
major construction projects closely reflects the requests by VA, and exceeds, by
nearly double, the FY2012 appropriations request for this line item. However, at
this rate of authorization and funding, VA will not have the financial resources
available to reach their capital planning goals outlined though VA’s Strategic
Capital Investment Planning (SCIP). The authorization for medical facility
leases fulfills VA’s request for establishing eight community-based outpatient
clinics. The VFW agrees with this level of authorization.

Section 6 outlines the new authority for VA’s enhanced-use lease ( (EUL).
Most importantly, this bill will extend EUL. Without this extension, which is
due to expire December 31, 2011, VA will be limited in their ability to reduce
homelessness and effectively use properties that are either vacant or
underutilized. The VFW agrees with most of the amendments of EUL authorization
including the consideration of EUL business plans beyond those proposed by the
Under Secretary of Health, ensuring the leases comply with current scorekeeping
rules, ensuring that VA’s liability is limited, clarification of payment of
State and local taxes, and that funds derived from EUL will be deposited into
VA’s Major and Minor construction accounts.

The VFW does have concerns with the amendment that removes the criteria that
mandates EUL properties must “actively contribute to VA’s mission.” Removal of
this provision could change the focus of VA from providing care for veterans to
improving revenue of existing properties. Maintaining and improving care for
veterans must always be the single focus of VA. Also, any revenue that is
produced through the EUL program that would be shifted to VA’s Major and Minor
construction accounts through the passage of this bill must be a supplement to,
and not a substitute for, appropriating funds for these accounts.

The VFW agrees with Section 7 of this legislation. Currently, VA requests
construction funding for the actual cost of construction, but leaves out
activation costs. Section 7 would ensure that VA requests the full cost of
construction costs.

The VFW holds no opinion on the naming of VA facilities. Therefore, the VFW
provides no comment on Section 8 of this legislation.

The VFW supports all of the extensions of the expiring authorities that are
found in Section 9 of this legislation.

Madam Chairwoman, this concludes my statement. I would be happy to answer any
questions that you or the Members of the Committee may have.

Madam Chairwoman, Ranking Member Michaud, and Members of the Subcommittee:

Thank you for inviting me to testify on behalf of the Disabled American
Veterans (DAV) at this important hearing of the Subcommittee on Health. DAV is
an organization of 1.2 million service-disabled veterans. We devote our energies
to rebuilding the lives of disabled veterans and their families.

Madam Chairwoman, the DAV appreciates your leadership in enhancing Department
of Veterans Affairs (VA) health care programs on which many service-connected
disabled veterans must rely. At the Subcommittee’s request, the DAV is pleased
to present our views on five numbered bills and two draft measures before the
Subcommittee today.

H.R. 198—the “Veterans Dog Training Therapy Act”

If enacted, this bill would require the Secretary of Veterans Affairs within
120 days of enactment to conduct a pilot program for certain veterans through
the therapeutic medium of service dogs. The pilot program would include the
provision of training, exercising, feeding, grooming and quartering of dogs by
VA for veterans with post-deployment mental health challenges for use as service
animals. The stated purpose of the pilot program would be to determine how
effectively it would assist veterans with post-traumatic stress disorder (PTSD)
in reducing mental health stigma; improving emotional stability and patience;
reintegrating into civilian society; and, making other positive changes that aid
veterans’ repatriation after combat. The bill would require a VA study to
document such efficacy and a series of reports to Congress.

Madam Chairwoman, we do not have an approved resolution from our membership
that addresses this specific topic, so we are unable to take a formal position
on this bill. We are supportive of VA’s current policy on admittance of service
animals to VA facilities provided it is carried out uniformly nationwide. Also,
DAV is looking forward to the receipt of findings from VA’s ongoing research
project to determine the efficacy of service dog usage by veterans challenged by
mental illness and other mental health conditions related to combat deployments
including PTSD. We recognize that trained service animals can play an important
role in maintaining functionality and promoting maximum independence and
improved quality of life for persons with disabilities—and that pilot programs
such as the one proposed could be of benefit to certain veterans.

H.R. 1154—the “Veterans Equal Treatment for Service Dogs Act”

This bill would prohibit the Secretary of Veterans Affairs from restricting
the use of service dogs by veterans on any VA property that receives funding
from the Secretary.

Madam Chairwoman, similar to our lack of a resolution on the above bill, we
do not have a resolution on this topic either. The Veterans Health
Administration (VHA) has published a national policy directive on admittance of
service and guide animals to VA health care properties and into its facilities
on those properties. A number of complaints have arisen from our members
strongly suggesting the actual local policies enforced by facility or network
management may differ markedly from VA’s national policy, and that VA makes a
distinction between service, guide and “companion” animals, admitting some and
restricting others. We believe the current national policy, VHA Directive
2011-013, is adequate and that local enforcement of it clearly addresses this
issue and could accomplish the goal of this measure. Therefore, we recommend the
Subcommittee provide oversight to ensure standardization of the policy and
extension of the policy for VA regional offices under the Veterans Benefits
Administration (VBA). We are unaware that VBA has a published policy on veterans
and service/guide dogs.

Madam Chairwoman, this measure is similar to a bill introduced by the same
sponsor, Mr. Walz of Minnesota, at the end of the 111th Congress. We strongly
support this bill. If enacted, it would clarify the definition of
“rehabilitation” as that term is understood in title 38, United States Code, to
strengthen VA’s mandate to sustain gains made in the rehabilitative process in
veterans who have incurred traumatic brain injuries. The bill would focus VA on
behavioral, mental health, cognitive and functions of daily living, in an effort
to assure that veterans achieve and sustain maximal recovery from the trauma and
lasting effects of brain injury.

Our members have approved a national resolution calling for better VA
treatments and more research to ensure veterans with traumatic brain injury
receive the best care possible. This bill aims to fulfill the goals of
maximizing an individual’s independence and quality of life and is fully in
keeping with DAV Resolution 215. We commend its sponsors and urge the
Subcommittee to recommend its enactment as a high priority.

H.R. 2074—the “Veterans Sexual Assault Prevention Act”

Madam Chairwoman, we appreciate your introduction of this measure following
information that came to light earlier this summer indicating a number of sexual
assaults occurring in VA facilities had not been properly reported. I had the
privilege of testifying before this Subcommittee on that topic, including
providing commentary on the Government Accountability Office (GAO) report
presented to the Subcommittee at that same hearing.

As I indicated in my earlier testimony, every veteran should be assured of
the highest level of quality care and patient safety while receiving health care
in a VA facility. A veteran should never fear for his or her own personal safety
while visiting a VA facility. VA was established as a place of care, not a place
of fear, for veterans, visitors or staff.

We concur with GAO that when a veteran has a history of sexual assault or
violent acts, VA must be vigilant in identifying the risks that such veterans
pose to the safety of others at its medical facilities. When a sexual assault
involves a VA employee, whether perpetrator or victim, the incident takes on
even more meaning, and raises a host of questions that were explored by the GAO,
and also discussed during your recent hearing. VA needs to take decisive actions
to improve personal safety and promote an environment of care that includes
protection from personal assaults, including sexual assaults. To do so will take
a commitment from all levels of VA and especially VA’s senior leadership. We
commend GAO for making this critical report. Hopefully, GAO’s findings can serve
VA and veterans well in providing a roadmap to promote a new environment of care
that encompasses a strong consistent culture of safety, and one that can be
closely monitored by this Subcommittee as VA completes the recommended changes.

Madam Chairwoman, your bill firms up VA’s requirement to document, track and
control—and hopefully, to eliminate—incidence of sexual assaults that occur on
properties and grounds of the VA. We believe the bill, if enacted, would be
consistent with GAO’s findings and would serve veterans and VA well as a means
of greater accountability and transparency of VA’s actions in combating sexual
assaults and related incidents affecting the safety of veterans and VA staff.

H.R. 2530—“To amend title 38, United States Code, to provide
for increased flexibility in establishing rates for reimbursement of State homes
by the Secretary of Veterans Affairs for nursing home care provided to veterans”

H.R. 2530, introduced by the Subcommittee Ranking Member and the full
Committee Chairman, would revise the methodology used to reimburse State
veterans homes that provide nursing home care for veterans with
service-connected disabilities rated 70 percent or greater or for veterans who
need nursing home care due to a service-connected disability. The
legislation is intended to amend existing statute and restore the original
intent of Section 211 of Public Law 109-461, which was enacted in order to
authorize VA to place 70 percent service-connected veterans in State Homes and
to reimburse them at rates comparable to those received by contract community
nursing homes.

DAV strongly supported establishment of the authority contained in Public Law
109-461 that confirmed a VA responsibility to provide full-cost reimbursement to
the States for the care of service-connected veterans in order to expand the
long-term care options for these highest priority veterans. However, as we noted
in prior testimony before this Subcommittee, Public Law 109-461 was enacted in
December 2006, but unfortunately VA only promulgated regulations to carry out
its intent in April 2009.

The law established State veterans home reimbursement rates for
service-connected veterans using two formulas: a geographically adjusted per
diem rate established by the Secretary as a corollary to the rates VA currently
pays community nursing homes; or, a rate determined by the administrator of a
State veterans home based on the calculated daily cost of care at that home. The
law also required the Secretary to reimburse State veterans homes for the care
of service-connected veterans at the lesser of these two rates.

However, the final promulgated rule contained an unexpected complication when
the Office of Management and Budget (OMB) applied the governing financial and
accounting policy expressed in OMB Circular A-87. This circular establishes
principles and standards for determining costs for Federal awards carried out
through grants, cost reimbursement contracts, and other agreements with State
and local governments. Under the rules of this circular, a State Home, in
determining its daily cost of care, cannot include in that cost structure the
depreciation of buildings that were recipients of VA construction grants. As
stated in the circular, “[t]he computation of depreciation or use allowances
will exclude: … (2) Any portion of the cost of buildings and equipment borne by
or donated by the Federal Government irrespective of where title was originally
vested or where it presently resides.” This restriction on counting depreciation
as a part of a home’s daily cost of care significantly depresses the payable
reimbursement rates. As a result of the State Homes’ excluding these significant
amounts, the rates determined by the existing statutory formula will invariably
become the OMB Circular A-87-determined rates.

Since publication of these regulations, many State Homes have found that the
“full” reimbursement rates governed by VA regulations will net their facilities
less than their combined payments (from veterans, their State governments, the
Department of Health and Human Services, and from VA under the traditional per
diem payment subsidy) received before these regulations were issued. Most of the
State Homes that were already providing care for service-connected veterans
suffered significant decreases in revenue, and other State Homes that were
considering placements of service-connected veterans determined that the could
not afford to extend such care at the reimbursement rates being offered under
the new regulation. As a result, the current statutory language in section
1745(a)(2) is unworkable for the purpose intended by Congress. The unworkability
of these rates has served as a denial of access to nursing home care in State
extended care facilities to the highest priority veterans, those who need
nursing home care for residuals of chronic illnesses and injuries they incurred
in military service to America. As a result, the intention of Congress to expand
long-term care options for the most seriously disabled service-connected
veterans has not been achieved.

Over the past 2 years, VA and State Homes have been working towards a
solution that would meet the original intent of Congress in a manner that would
be viable for State Homes. Earlier this year, VA submitted draft health care
legislation to Congress that contained a provision designed to remedy this
situation. The language VA developed in consultation with State homes would end
the current reimbursement methodology and replace it with new language requiring
VA to, “…enter into a contract (or agreement under section 1720(c)(1) of this
title) with each State home for payment by the Secretary for nursing home care
provided in the home.” This provision is intended to reimburse State homes at
rates comparable to those currently paid to contract community nursing homes
that provide care. The bill also contained language requiring the development of
new payment methodologies that will “adequately reimburse the State home for the
care provided by the State home under the contract (or agreement).” VA has
stated that the use of contracts would “…allow the most flexibility to VA and
States to ensure that States are paid adequately and according to the complexity
and severity of illness of each Veteran.” VA intends to use contract templates
to streamline the contract process, which would include standard language for
pricing based on prevailing rates in the community.

Madam Chairwoman, DAV is hopeful that this legislation will address the
problems in the current statutory language and VA’s current regulations, and
will finally provide a route to resolve this problem. We have some concerns
about whether OMB may continue to assert that Circular A-87 would be a
controlling factor in determining the level of reimbursement despite the
intention of Congress and VA and suggest the Subcommittee may want to make clear
its intention on this point in report language. DAV commends the bill’s sponsors
for their continuing efforts to ensure that our highest priority veterans may
have the option of entering a State home to meet their long-term care needs, and
we recommend enactment of H.R. 2530.

Draft Bill—the “Honey Sue Newby Spina Bifida Attendant Care
Act”

This bill would establish assisted living and attendant care services for
children of certain Vietnam veterans who are challenged by spina bifida. We have
not received a resolution from our membership dealing with this specific issue;
therefore, we can take no formal position on this bill. However, we are
supportive of assisted living options as an alternative to institutionalized
care; therefore, DAV would not object to its enactment. Nevertheless, we note
that Congress has not further considered establishing an assisted living
authority within the VA even though a 2004 study on VA’s Congressionally
mandated assisted living pilot program showed great promise and high acceptance
by veterans as an alternative to institutional long-term care. We hope that in a
future hearing we will be able to testify in support of a new VA assisted living
program.

This bill would authorize a number of major medical facility construction
projects and capital leases, as well as authorize the appropriations that
support these projects. It would also modify previous Congressional
authorizations of projects for a number of facilities and modify and provide VA
more flexibility in the existing enhanced-use lease authority under which VA may
dispose of unnecessary properties by leasing them to outside entities for
compatible-use purposes.

The bill would authorize proceeds from enhanced-use leases to be deposited to
accounts used by VA to fund minor and major capital projects. The bill would
alter existing cost-comparison studies required in title 38, United States Code,
section 8104, as VA contemplates pursuing medical facility acquisition versus
proposing new construction for major medical facility appropriations accounts.
The bill would authorize the naming of a telehealth clinic in Craig, Colorado.
Finally, the bill would extend a number of existing but expiring authorities of
law.

Madam Chairwoman, we have no resolution from our membership covering these
various matters, but DAV would offer no objections to enactment of this bill. We
appreciate the Subcommittee’s continuing support of VA’s capital needs to ensure
the VA health care system is modernized and meets standards for contemporary
health care delivery.

Madam Chairwoman, this completes my testimony. Thank you again for inviting
Disabled American Veterans to present this testimony today. I would be pleased
to address questions from you or other Members of the Subcommittee.

Chairwoman Buerkle, Ranking Member Michaud, and Distinguished Members of the
House Veterans Affairs Subcommittee on Health, Vietnam Veterans of America (VVA)
thanks you for the opportunity to present our views on pending legislation for
veterans and their families

H.R. 198, Veterans Dog Training Therapy Act, Directs the Secretary of
Veterans Affairs to carry out a pilot program for assessing the effectiveness of
addressing post-deployment mental health and post-traumatic stress disorder
symptoms through a therapeutic medium of service dog training and handling for
veterans with disabilities. Requires such program to be carried out at
Department of Veterans Affairs (VA) medical centers that can provide training
areas for such purposes.

Although VVA generally supports this legislation, we have several questions:
1) What certification standards will be used to ensure that the animals can
perform essential service dog skills?; and 2) What quantitative
metrics/measurements will be used to measure the impact of the service dogs on
the psychosocial, mental health and physiological disorders suffered by the
participating veterans?

H.R. 1154, Veterans Treatment of Service Dogs Act, Prohibits the
Secretary of Veterans Affairs (VA) from prohibiting the use of service dogs in
or on any VA facility or property or any facility or property that receives VA
funding.

VVA generally supports this legislation, but again asks the question:
What constitutes certification of one’s animal as a “service dog?”

H.R. 1855, Veterans Traumatic Brain Injury Rehabilitative Services Act of
2011, Includes within a program of individualized rehabilitation and
reintegration plans for veterans with traumatic brain injury (TBI): (1) the goal
of maximizing the individual's independence and quality of life, and (2)
improving such veterans' behavioral and mental health functioning. Requires the
inclusion of rehabilitative services in a Department of Veterans Affairs (VA)
comprehensive program of long-term care for veterans' TBI that has residential,
community, and home-based components utilizing interdisciplinary treatment
teams.

VVA strongly supports this legislation, and it is very clear that Command
Sergeant Major Walz understands the necessity for broadly integrated and
individualized psychosocial, mental health, and physical treatment plans and
services in order maximize the quality of long-term care and quality of life for
our veterans suffering from TBI.

employees communicating and reporting incidents to specified supervisory
personnel, VA law enforcement officials, and the Office of Inspector General;
(4) an oversight system within the Veterans Health Administration; (5)
procedures for VA law enforcement officials investigating, tracking, and closing
reported incidents; and (6) clinical guidance for treating sexual assaults
reported over 72 hours after assault.

Requires the Secretary to: (1) submit an annual report to Congress on such
incidents and policy implementation, and (2) prescribe applicable regulations.

VVA strongly supports this legislation as an initial effort to address and
correct the failures of the VA for protecting and safeguarding our veterans in
VA facilities as noted in the June 2011 GAO report.

H.R. 2530, To amend title 38, United States Code, to provide for
increased flexibility in establishing rates for reimbursement of State homes by
the Secretary of Veterans Affairs for nursing home care provided to veterans.

VVA strongly supports this legislation as H.R. 2530 would correct problems
that arose during the implementation of section 211 of P.L. 109-461 affecting
State Veterans Homes. With enactment of that law, Congress intended to
change the reimbursement mechanism so that State Veterans Homes could provide
nursing home care to veterans with service-connected disabilities rated 70
percent or greater and be reimbursed at rates comparable to those provided to
community contract nursing homes that provide such care. However, the
manner in which VA implemented the new regulations resulted in an unexpectedly
low reimbursement rate that actually had the reverse outcome: State Homes now
cannot afford to provide care to these, the most seriously disabled veterans.

The proposed legislation introduced by Congressman Michaud would correct this
problem by changing the statutory authority so that VA could enter into
contracts or agreements with State Homes that would reimburse the homes for
providing care to veterans rated 70 percent or greater, and be adequately
reimbursed based on a new methodology to be developed by the VA in consultation
with the State Homes. The language of H.R. 2530 is virtually identical to
that which VA has proposed in draft legislation submitted to Congress earlier
this year, and is the result of months of negotiations between VA and the
National Association of State Veterans Homes. This legislation will
achieve the goals of the original law, which was to provide veterans with
service-connected disabilities rate 70 percent or greater with an additional
option, which may be more convenient, provide better care and usually costs less
to the Federal government than the same care provided through VA-operated
nursing homes or contract community homes.

Honey Sue Newby Spina Bifida Attendant Care Act draft legislation: To
amend title 38, United States Code, to authorize the Secretary of Veterans
Affairs to provide assisted living services to certain children of Vietnam
veterans who are suffering from spina bifida.

VVA strongly supports this legislation as it will provide decades-long
over-due services to the Vietnam veteran parents of now middle-aged children
suffering from spina bifida.

Veterans Health Care Facilities Capital Improvement Act of 2011 draft
legislation:. To authorize certain Department of Veterans Affairs major
medical facility projects and leases, to extend certain expiring provisions of
law, and to modify certain authorities of the Secretary of Veterans Affairs, and
for other purposes.

Although this legislation calls for needed construction modifications at a
number of VA medical facilities, VVA cannot support this legislation in its
present form as it is unclear as to whether the proposed changes suggested in
Section 6. “Modification of Department of Veterans Affairs Enhanced-Use Land
Authority” will eliminate any possible breaches of VA fiduciary duty for leasing
property to private entities, as has been alleged to have occurred at the West
Los Angeles Medical Center and Community Living Center campus.

Once again, on behalf of VVA National President John Rowan and our National
Officers and Board, I thank you for your leadership in holding this important
hearing on this legislation that is literally of vital interest to so many
veterans, and should be of keen interest to all who care about our nation’s
veterans. I also thank you for the opportunity to speak to this issue on behalf
of America’s veterans.

While PVA has no specific position on this proposed legislation, we believe
that it could be beneficial therapy for veterans dealing with Post-Traumatic
Stress Disorder (PTSD) and other mental health issues. A model program for this
service was created in 2008 at the Palo Alto VA Medical Center in conjunction
with the Assistance Dog Program. This program, maintained by the Recreational
Therapy Service at the Palo Alto VAMC, is designed to create a therapeutic
environment for veterans with post-deployment mental health issues and symptoms
of PTSD to address their mental health needs. Veterans participating in this
program train service dogs for later placement with veterans with hearing and
physical disabilities. As we understand it, a similar, privately-funded, pilot
program is currently underway at Walter Reed Army Medical Center (WRAMC) where
service dogs have been used in therapeutic settings since 2006.

In these programs, training service dogs for fellow veterans is believed to
be helping to address symptoms associated with post-deployment mental health
issues and PTSD in a number of ways. Specifically, veterans participating in the
programs demonstrated improved emotional regulation, sleep patterns, and sense
of personal safety. They also experienced reduced levels of anxiety and social
isolation. Further, veterans’ participation in these programs has enabled them
to actively instill or re-establish a sense of purpose and meaning while
providing an opportunity to help fellow veterans reintegrate back into the
community. Given the apparent benefit to veterans who have participated in
similar programs as the one proposed by H.R. 198, we see no reason to oppose
this legislation.

While we believe this legislation should be unnecessary based on the
provisions of Section 504 of the Rehab Act, the actions of the VA clearly
demonstrate the need for this legislation. If the VA is unwilling to make the
regulatory change to accomplish the intent of H.R. 1154, then we hope Congress
will move quickly to enact this important legislation.

PVA fully supports H.R. 1855, the “Veterans Traumatic Brain Injury
Rehabilitative Services’ Improvement Act of 2011.” If enacted, H.R. 1855 would
ensure that long-term rehabilitative care becomes a primary component of health
care services provided to veterans who have sustained a Traumatic Brain Injury
(TBI). Specifically, this legislation would change the current definition of
“rehabilitative services” to include maintaining veterans’ physical and mental
progress and improvement, as well as maximizing their “quality of life and
independence.”

As we have testified on previous occasions, TBI is one of the most common and
complex injuries facing veterans returning from the current wars in Afghanistan
and Iraq. Today, we still do not fully understand the impact or gravity of TBI.
In April 2008, the RAND Corporation Center for Military Health Policy Research
completed a comprehensive study titled Invisible Wounds of War: Psychological
and Cognitive Injuries, Their Consequences, and Services to Assist Recovery.
RAND found that the effects of TBI were poorly understood, leaving a gap in
knowledge related to how extensive the problem is or how to handle it. RAND
found 57 percent of those reporting a probable TBI had not been evaluated
by a physician for brain injury. Military service personnel who sustain
catastrophic physical injuries and suffer severe TBI are easily recognized, and
the treatment regimen is well established. In recent testimony, PVA has raised
continuing concerns about servicemembers who do not have the immediate outward
signs of TBI getting appropriate care. The military has implemented procedures
to temporarily withdraw individuals from combat operations following an
improvised explosive device (IED) attacks for an assessment of possible TBI,
creating a significant military impact, but believing it necessary for soldier
health even if it reduced combat forces.

On July 12, 2006, the VA Office of the Inspector General (OIG) issued
Health Status of and Services for Operation Enduring Freedom/Operation Iraqi
Freedom Veterans after Traumatic Brain Injury Rehabilitation. The report
found that better coordination of care between DoD and VA health-care services
was needed to enable veterans to make a smooth transition. While VA and DoD have
done extensive improvements of coordination since that report, the OIG Office of
Health Care Inspections conducted follow-on interviews to determine changes
since the initial interviews conducted in 2006. The OIG concluded that 3 years
after completion of initial inpatient rehabilitation, many veterans with TBI
continue to have significant disabilities and, although case management has
improved, it is not uniformly provided to these patients.

Because all the impacts of TBI are still unknown, this legislation to expand
services and care, providing for quality of life and not just independence, and
emphasizing rehabilitative services, is important to the ongoing care of TBI
patients. It is imperative that a continuum of care for the long term be
provided to veterans suffering from TBI. This bill will address the intricacies
associated with TBI and help veterans and their families sustain rehabilitative
progress.

H.R. 2074, the “Veterans Sexual Assault Prevention Act”

PVA fully supports H.R. 2074, a bill that would require a comprehensive
policy on reporting and tracking sexual assault incidents and other safety
incidents that occur at VA medical facilities. PVA believes policy mandates that
specifically outline how sexual assaults within the VA should be handled are
long overdue. The implementation of polices involving sexual assault will
reinforce veterans’ confidence in the VA’s ability to provide a safe environment
for care.

H.R. 2074 will require VA to develop and implement a centralized and
comprehensive policy on the reporting and tracking of sexual assaults and safety
incidents that occur at each medical facility. While the proposed legislation
provides clear examples and definitions of the types of assaults and incidents
that are to be reported, further detail and interpretation is need for the term
“centralized.”

Although daily management of VA medical facilities is under the supervision
of Veteran Integrated Service Networks (VISNs), PVA recommends that the proposed
legislation require the leadership of each VISN to be responsible for the
centralized reporting, tracking, and monitoring system, while also requiring the
VISNs to provide the tracking reports to VA’s Veterans Health Administration
(VHA) central office. Such information sharing will enhance accountability and
case management, and make data readily available when monitoring incidents or
conducting assessments of the newly implemented system. Additionally, PVA
recommends that VA provide clear and concise policy guidance that includes a
specific time frame in which front-line VA personnel responsible for the initial
processing of assault claims must begin processing the report.

PVA also believes that a major component of preventing and appropriately
handling sexual assaults and other incidents is ensuring that all occurrences of
such events are reported by not only VA personnel, but veterans and other
visitors as well. VA medical facilities must provide safe and secure
environments for veterans and their families seeking care and services.
Therefore, PVA recommends that the proposed legislation include language that
requires VA medical facilities to post clear and precise guidance on ways in
which individuals visiting VA facilities can safely report sexual assaults and
safety incidents.

H.R. 2530

PVA generally supports H.R. 2530 to allow for increased flexibility in
establishing rates for reimbursement for State veterans’ homes, but believes
greater understanding of the problem is needed. The State Veterans Home Program
is examined in great detail in The Independent Budget for FY 2012. Those
comments are reflected here in our statement for H.R. 2530. The VA State
Veterans Home Program currently encompasses 137 nursing homes in 50 States and
Puerto Rico, with more than 28,000 nursing home and domiciliary beds for
veterans and their dependents. State veterans homes provide the bulk of
institutional long-term care to the nation’s veterans. The GAO has reported that
State homes provide 52 percent of VA’s overall patient workload in nursing
homes, while consuming just 12 percent of VA’s long-term care budget. VA’s
authorized average daily census (ADC) for State veterans’ homes was 19,208 for
FY 2008 and was projected to be approximately 19,700 for FY 2010.

VA holds State homes to the same standards applied to the nursing home care
units it operates. State homes are inspected annually by teams of VA examiners,
and VA’s Office of Inspector General (OIG) also audits and inspects them when
determined necessary. State homes that are authorized to receive Medicaid and
Medicare payments also are subject to unannounced inspections by the CMS and
announced and unannounced inspections by the OIG of the Department of Health and
Human Services. VA pays a small per diem for each veteran residing in a State
home, currently at a rate of $77.53 per day. This is less than one-third of the
average cost of that veteran’s care. The remaining two-thirds is made up of a
mix of funding, including State support, Medicaid, Medicare, and other public
and private sources. In contrast, VA pays Community Nursing Homes over $200 per
day with the cost of care in VA Community Living Centers (VACLC) at almost $800
per day.

Service-connected veterans should be the top priority for admission to State
veterans’ homes, but traditionally they have not considered State homes an
option for nursing home services because of lack of VA financial support. To
remedy this disincentive, Congress provided authority for full VA payment.
Unfortunately, veterans with severe disabilities may be put at a disadvantage in
gaining access to State veterans’ homes. As part of P.L. 109-461, the “Veterans
Benefits, Health Care, and Information Technology Act of 2006,” Congress
approved payment of different per diem amounts by VA to State veterans’ homes
which provide nursing home care to veterans with service-connected disabilities,
a program dubbed “the 70 Percent Program.” VA issued regulations for this
program in April 2009 and granted a higher per diem rate for veterans with
service-connected disabilities. Unfortunately, PVA is hearing reports that these
rates have resulted in lower payments to many State veterans’ homes and in some
cases are less than the actual cost of care.

PVA believes VA made a good faith effort in establishing the original rates,
but may not have taken into consideration the significantly greater cost of care
for those with severe disabilities, in particular those service-connected
veterans with 70 percent or greater rating. As a result, we are concerned that
many severely disabled veterans who would choose to use the State veterans’
homes will be denied access simply because the veterans’ home cannot afford the
cost of their care. This will cause a significant impact on our veterans most in
need at a time when VA is continuing to reduce their capacity to provide
long-term care facilities.

PVA has been informed by representatives of the National Association of State
Veterans Homes (NASVH) that VA seems resistant to modifications of the per diem
rate or alternatives that may provide greater reimbursement rates. There is a
sense that the VA believes the lower rate is appropriate because VA shoulders a
great financial burden when it helps cover the cost of construction,
rehabilitation, and repair of State veterans’ homes, providing up to 65 percent
of the cost, with the State providing at least 35 percent. If true, PVA believes
this argument is invalid.

In FY 2011 the construction grant program was funded at only $85 million, the
same amount Congress had provided in multiple previous fiscal years. Based on a
current backlog of nearly $1 billion in grant proposals, and with thousands of
veterans on waiting lists for State beds, The Independent Budget for FY
2012 recommends no less than $200 million for this program. Unfortunately,
Congress seems poised once again to only provide $85 million for the State homes
grant program. The VA is using this grant program as an incentive to build more
capacity to avoid the greater cost of building it themselves. PVA firmly
believes that construction costs should not be mixed with health care costs. The
per diem rate should be independent of any quid pro quo VA may believe
exists with the State veterans’ homes due to construction funding. State
veterans homes can provide high quality care at a rate cheaper than VA and
should be rewarded for doing so, not punished.

VA’s significant inventory of real property and physical infrastructure is a
truly remarkable asset in the provision of health care and benefits delivery to
veterans. At the same time, these facilities must be properly managed and cared
for to ensure that the investment made in the use of these buildings and
properties coincides with the benefits derived from their use.

In the same manner, as the VA begins with the manipulation, sale or leasing
of its infrastructure, great care must be taken to ensure that the value and
equity in VA’s physical property is not squandered. That equity does not belong
to the VA or the Federal Government; it belongs to the veterans of the nation
for their future good. With any rearrangement of VA facilities great care should
be taken to make certain present as well as future needs of veterans are fully
accounted for.

With that caveat, we believe the legislation before the Subcommittee does
provide the VA with improved flexibility in leasing unused or underused
properties. VA enhanced use lease authority is almost unique among other Federal
departments and agencies. Unfortunately, however, the process has been called
cumbersome and time consuming, discouraging VA Administrators from wanting to
expend the effort to use this route in dealing with a property. Such a lengthy
process also greatly discourages potential private sector entities from
considering VA properties as a potential investment asset. PVA is pleased to see
that the legislation retains the Capital Assets Fund to serve as the repository
for the proceeds from the sale or lease of VA properties and then act as the
conduit for the reinvestment of those proceeds for the improvement of other VA
facilities. We also find it interesting that the Committee calls for these
proceeds to be reinvested into Major and Minor Construction, rather than the
Medical Care Collections Fund.

However, we have two areas of caution as the Committee moves forward. First,
VA, with proper Congressional oversight, must ensure that it receives fair
market value and appropriate leases for these properties. This is particularly
important in light of the current real estate market climate. Second, Congress
must ensure that proceeds reinvested into Major and Minor Construction are not
looked upon by the Office of Management and Budget, as well as the Budget and
Appropriations Committees, as an alternative to, and not over and above regular
funding for needed specific construction appropriations. Ultimately, we do not
want to see VA major and minor construction funding or non recurring maintenance
budget line items offset by Capital Asset Fund disbursements.

PVA is particularly pleased that the Subcommittee has chosen to reauthorize a
number of programs targeted at assisting homeless veterans. However, we would
encourage the Subcommittee to include reauthorization of the Homeless Veterans
Reintegration Program (38 U.S.C. §2021) managed by the Department of Labor. The
HVRP is a valuable program focusing on employment of homeless veterans. This
program has achieved wonderful success since its inception approximately 25
years ago. The HVRP provides help for those veterans with significant problems
including substance-use disorder, severe PTSD, serious social problems, legal
issues and HIV. The specialized services needed for these veterans and provided
by HVRP are often their only hope.

Draft “Honey Sue Newby Spina Bifida Attendant Care Act”

This legislation would amend Title 38 U.S.C., to provide additional benefits
for children with spina bifida of veterans exposed to herbicides while serving
in the Armed Forces during in Vietnam. PVA supports this legislation as it would
simply improve upon the benefits that already exist for this beneficiary
population.

Madame Chairwoman and Members of the Subcommittee, once again PVA would like
to thank you for the opportunity to offer our views on the legislative matters
pending before the Subcommittee. We look forward to working with you to ensure
that meaningful reforms that best benefit veterans are made to the health care
services provided by the VA.

This concludes our official statement. I would be happy to answer any
questions that you may have.

Chairwoman Buerkle, Ranking Member Michaud and distinguished Members of the
Subcommittee, on behalf of AMVETS, I would like to extend our gratitude for
being given the opportunity to share with you our views and recommendations at
today’s hearing regarding: H.R. 198, the “Veterans Dog Training Therapy Act,”
H.R. 1154, the “Veterans Equal Treatment for Service Dogs Act,” H.R.
1855, the “Veterans Traumatic Brain Injury Rehabilitative Services Act of
2011,” H.R. 2074, the
“Veterans Sexual Assault Prevention Act,” H.R. 2530, to amend Title
38, United States Code, to provide increased flexibility in establishing rates
for reimbursement of State Homes by the Secretary of Veterans Affairs for
nursing home care provided to veterans,” draft legislation, the “Veterans
Health Care Capital Facilities Improvement Act of 2011,” and draft
legislation, the
“Honey Sue Newby Spina Bifida Attendant Care Act.”

AMVETS feels privileged in having been a leader, since 1944, in helping to
preserve the freedoms secured by America’s Armed Forces. Today our organization
prides itself on the continuation of this tradition, as well as our undaunted
dedication to ensuring that every past and present member of the Armed Forces
receives all of their due entitlements. These individuals, who have
devoted their entire lives to upholding our values and freedoms, deserve nothing
less.

Given the fact, this testimony will be addressing multiple pieces of
legislation; we shall be addressing each piece of legislation separately, as to
make AMVETS testimony clear and concise on the individual subject matters of the
bills.

AMVETS supports H.R. 198, the “Veterans Dog Training Therapy Act.” AMVETS
lends our support to the updated language of H.R. 198 that will be submitted in
Committee markup. AMVETS believes the updated language will help ensure that
H.R. 198 provides veterans the highest quality care, while maintaining our
commitment to fiscal responsibility.

By way of background, AMVETS has worked with Assistance Dogs International
(ADI) accredited Assistance Dog agency, Paws With A Cause for over 30 years, in
an effort to help provide disabled veterans Service Dogs. Through this
partnership, AMVETS has seen what an immeasurable asset to a veteran’s overall
wellbeing these service dogs have proven to be to both the trainers and
recipients. AMVETS has personally witnessed the incredible changes that occur
when introducing a dog into a veterans overall treatment plan. This is often
illustrated through speedier improvements to a veteran’s physical wellbeing,
great improvements to the veteran’s mental health and a sustainable overall
higher quality of life, when compared to the pace of improvements shown in
veterans undergoing normal clinical care.

Veterans who are able to take on an active role in the training of a Service
Dog have displayed great improvements to their overall wellbeing and recovery.
H.R. 198 is an opportunity for a veteran to once again feel that they have
purpose and will be able to play an active role in assisting his/her comrades,
just as he/she did while serving in the military. H.R. 198 will also offer a
structured program that has clear and concise rules, goals and measurable end
results.

Furthermore, AMVETS believes H.R. 198 will prove to be beneficial to the
veteran trainers, the veteran Service Dog recipient and to the Department of
Veterans Affairs. AMVETS also believes H.R. 198 will aide VA in the development
of stronger policies and procedures regarding Service Dogs within the VA health
care system, as well as being fiscally responsible through the collaborating of
VA facilities with private sector industry experts, ADI agencies for this study.
The VA and ADI partnership will ensure the quality of the training process and
uniform training standards for the program, provide both a therapeutic, yet
professional setting for all parties involved in the study, ensure the safety of
both the veterans and the dogs and provide industry expertise and job training
skill sets to veterans chosen to participate. AMVETS also applauds Congressman
Grimm for going the extra step by finding multiple choices for offset funding.

“Dogs and other animals. Dogs and other animals, except
seeing-eye dogs, shall not be brought upon property except as authorized by
the head of the facility or designee”.

AMVETS finds the aforesaid language of 38 CFR, Part 1, § 1.218(a)(11), to be
inconsistent and outdated when compared to the sections of Title 38 it is to
govern. While numerous parts of Title 38, specifically Section 1714, are
constantly updated to reflect the health care needs of today’s wounded
warriors, 38 CFR, Part 1, § 1.218(a)(11) has been overlooked and has thus failed
to be updated since July of 1985. This outdated regulation is, to date,
resulting in disabled veterans utilizing VA approved Service Dogs as a
prosthetic device to be denied entrance into the VAMCs and CBOCs they depend on
for life sustaining care. Given the current authorities outlined by this
subsection, there continues to be wide spread inconsistencies in the policies
governing access to VAMCs and CBOCs. These inconsistencies are resulting in
disabled veterans who may have never experienced any sort of access problems at
their previous VAMC are now met with the serious issue of not being allowed to
enter a VA facility with their prosthetic device.

For example, Army veteran, Sue Downes lost both of her legs when her convoy
hit multiple IEDs in 2007 in Iraq. Today, after years of rehabilitation, Ms.
Downes utilizes several VA-provided prosthetic devices and her Service Dog,
which is considered a prosthetic device by VA, and thus is provided benefits for
its upkeep. These include her two prosthetic legs and her Service Dog, Lila. Ms.
Downes depends on her prosthetic legs for mobility and her Service Dog for
balance and further mobility assistance. Lila, Ms. Downes’ Service Dog, provides
her with not only mobility and balance, but just as important, independence.
Recently, while visiting with lawmakers in our nation’s capital, Ms. Downes
stated:

“I do not understand why VA will provide for the upkeep of both
prosthetic devices, my legs and my Service Dog, yet I am only allowed to
bring one of the two into VA facilities? I truly do not understand what the
reasoning behind this rule is; especially since my legs, on their own, are
not enough for me to safely get around. Lila was trained to and now provides
me assistance that no cane or walker could ever provide. Lila has given me
back my independence as a self sufficient mother of two and active member of
my community.”

AMVETS believes disabled veterans, such as Ms. Downes, using Service Dogs
must have the same access rights to VA care and facilities as currently afforded
to blind veterans using Guide Dogs. AMVETS also believes VA should never refuse
care to a veteran based on their disability or the prosthetic device they use to
assist them. Moreover, AMVETS believes H.R. 1154 will permanently eliminate the
aforesaid through updating the policies outlined by 38 CFR, Part 1, Section
1.218, as well as more accurately reflecting the policies outlined in 38 CFR,
Section 1714.

Recently, VA officials stated that H.R. 1154 was unnecessary due to the fact
that under existing statutory authority in 38 U.S.C. 901, VA can implement
national policy for all VA properties. While AMVETS somewhat agrees with this
statement, the fact remains that VA has been unwilling to exercise this
authority. In March of 2011, VA did somewhat exercise this authority through the
publication of VHA Directive 2011-013. However, AMVETS still believes the actual
regulation must be changed, since directives expire and are much harder to track
and to enforce compliance. As such, numerous VAMCs have incomplete, inconsistent
or non-existent access policies for Service Dogs. This creates a frustrating and
stressful experience for a veteran Service Dog user who must receive their
routine care at one VAMC, yet must go to a different VAMC for surgery or
specialty care. The individual VAMC access policies, if they exist, between the
two facilities will most likely be different, thereby creating an unnecessary
and avoidable hurdle to care these disabled veterans must now address.

For example, take Army veteran Kevin Stone. Mr. Stone suffered a severe
spinal cord injury while on active duty. Living in the foothills of the Smokey
Mountains, Mr. Stone uses Mountain Home VAMC for his routine health care.Yet,
the closest VA Spinal Cord Injury Care Center for Mr. Stone is Charlie Norwood
VAMC in August, Georgia. Unfortunately, in mid 2009, Mr. stone was caught off
guard when he was denied access to the facility for his annual SCI care. Mr.
stone was informed that only blind veterans were allowed to bring their dogs
into VA hospitals and that he would have to make other arrangements if he wished
to receive his SCI care. Finally after nearly 6 months of delayed care, a Member
of Congress had to get involved, just so Mr. Stone could receive his life
sustaining SCI care. Mr. Stone’s situation was stressful for all of the parties
involved and did not have to escalate to such levels. Mr. Stone’s situation
immediately brought forth concerns and questions for AMVETS on how many other
disabled veterans utilizing the assistance of a Service Dog have been denied
access to a VAMC or CBOC for care. As we are all aware, the simple fact remains
that not every disabled veteran using a Service Dog has access to a Member of
Congress for help in their case. This is only one of the many, many examples of
the challenges today’s disabled veterans utilizing Service Dogs, experience when
seeking care with the VA system.

While AMVETS applauds VA’s recent efforts in addressing this issue through
the publication of a temporary directive, we still strongly believe there are
loopholes that still need to be addressed and corrected in order to guarantee
veterans receive the care and services they need, regardless of their
disability. As we are all aware, directives expire and this issue needs a
permanent fix, right now. AMVETS has worked very closely with VA over the past
few years to assist in the development and implementation of policies and
procedures regarding Service Dogs. AMVETS strong support of H.R. 1154 is in no
way intended to be a criticism of VA or their actions in addressing this issue.
AMVETS strongly believes H.R. 1154 only stands to help, not hinder, VA in the
efforts through the codification of the new policy outlined in their directive
addressing Guide and Service Dogs on VA properties. With this in mind, H.R. 1154
will not only strengthen VA’s new efforts, but will also provide a permanent
correction through closing all possible loopholes and by implementing a
stronger, non-discriminatory, uniformed access policy.

AMVETS supports H.R. 1855, the “Veterans Traumatic Brain Injury
Rehabilitative Services Act of 2011”. While AMVETS is aware that Traumatic Brain
Injuries (TBI) are physical injuries, we are also aware of the psychological and
cognitive impact TBI can have on a veteran. The irrefutable medical data showing
the correlating symptoms of TBI and several psychological disorders clearly
illustrates the need for a more “holistic” approach in the treatment and care of
veterans who have sustained a Traumatic Brain Injury. This being said, AMVETS
strongly supports the language set forth by H.R. 1855, as we believe it will set
standards of care in which all aspects of a veterans TBI will be addressed. We
too often see veterans being treated for one injury at a time. AMVETS believes
VA needs to address and treat the veteran and their injuries as a whole, in
order to achieve the best physical and psychological outcomes of care. AMVETS
applauds Congressmen Walz and Bilirakis for their initiative, through the
introduction of H.R. 1855, in changing the way VA cares for TBI and its’ related
symptoms. AMVETS again lends our support to H.R. 1855.

AMVETS strongly supports H.R. 2074, the ‘‘Veterans Sexual Assault Prevention
Act.’’ AMVETS was, and still is, outraged by the Government Accountability
Office’s (GAO) report of findings regarding sexual assault in VA facilities,
released in early June 2011. AMVETS finds it even more disturbing that hundreds
of sexual assaults were not reported to VA leadership officials or the VA Office
of the Inspector General, which is in direct violation of VA policy and Federal
regulations. AMVETS finds it to be reprehensible that any veteran
receiving care in a VA facility would be subject and/or at risk of being
sexually assaulted or harassed. Moreover, AMVETS finds it inexcusable that VA
leadership, at all levels, has allowed such occurrences to continue to happen
without taking strong actions to protect the same veterans they have vowed to
protect and care for. While AMVETS also understands that top VA leadership was
not made aware of nearly 300 cases of sexual assault by VISN level leadership,
AMVETS still finds it inexcusable that stronger procedures and safeguards were
not already in place to address these types of matters before they escalated to
current levels. In 2011, VA has the ability to provide electronic limbs, state
of the art surgical procedures and world-class care to the veterans they serve.
With that being said, AMVETS must respectfully ask why VA cannot provide even
the most basic of safety measures in these same facilities? AMVETS concurs with
the Chairwomen’s statement that “Never should a warrior in need take the
brave step of getting help and be met with anything less than safe, supportive,
and high quality care in an atmosphere of hope, health, and healing.”
Furthermore, AMVETS also concurs with Chairman Miller’s statement that “In
the past week, some have dismissed these allegations, comparing the size of the
VA system and the number of allegations, to the private sector. Let me be very
clear on this point – there is no comparison. Just one assault of this nature,
one sexual predator, or one veteran’s rights being violated within the VA is one
too many and is absolutely unacceptable.” AMVETS applauds Congresswoman
Buerkle and Chairman Miller for their swift actions in an effort to correct
these gross and intolerable errors and urges all Members of Congress to follow
their lead through the swift passage of H.R. 2074.

AMVETS supports H.R. 2530, to amend Title 38 to provide increased flexibility
in establishing rates for reimbursement of State homes by the Secretary of the
Department of Veterans Affairs for nursing home care provided to veterans. At a
time in our nation’s history when we simultaneously have a large influx in aging
veterans requiring home care and disabled veterans returning with substantial
injuries also requiring home care, it is time to revisit the policies and
procedures associated with our State Veterans Homes (SVH). In December 2006,
P.L. 109-461, the “Veterans Benefits, Health Care, and Information Technology
Act of 2006”, authorized the VA to pay higher per-diem payments for care in SVHs
to certain veterans with service-connected disabilities. This long-awaited
regulation was issued in April 2009, with a retroactive effective date of March
2007. However, it took the VA 2 years to issue the rules and regulations to
implement P.L. 109-461 and yet the rates are still not up to par. Currently,
per-diem payments do not cover the full cost of providing services to veterans
residing in SVHs, which has resulted in many SVHs to lose millions of dollars
and even worse, due to these loses the inability to admit and care for more
severely disabled veterans in their facilities. This has become a huge problem
for the Medicare/ Medicaid certified SVHs operating in 31 States, because
current statutory language notes that the “per-diem rates paid by VA constitute
payment in full.” Thus, SVHs are prohibited from billing Medicare and
Medicaid for services they provide to disabled veterans, yet are not reimbursed
for by VA. These services include, but are not limited to, X-Rays, labs, PET
scans, dialysis and many other critical and medically necessary medical
procedures and tests. In reality the current “actual per-diem payments”
provided by VA to SVHs have increased, but the total reimbursement is much lower
than what SVHs received prior to the enactment of P.L. 109-461, as a result of
their inability to bill Medicare and Medicaid. This is an issue that has
been overlooked for too and has resulted in too many veterans not being able to
receive the care they need. AMVETS strongly supports H.R. 2530 and urges its
swift passage.

AMVETS also supports draft legislation, the ‘‘Veterans Health Care Facilities
Capital Improvement Act of 2011’’. AMVETS finds this piece of legislation to be
of the utmost importance. While the bill addresses several different matters,
AMVETS biggest concern is regarding VA’s enhanced lease program. As we are all
aware, Secretary Shinseki has laid out a plan who’s ultimate goal is to end
homelessness among veterans within 5 years. There has been no opposition to this
goal from any Member of Congress or the VSO community. It is a fair assumption
to believe we all want to end homelessness among our veteran population as soon
as possible. However, AMVETS believes a critical piece of the Secretary’s plan
is in danger of being eliminated. More specifically, VA’s enhanced lease
program.

VA’s enhanced lease program is responsible for, and comprised of facilities
used for, over 95 percent of VA’s homeless and at risk veteran and family
housing units. If this program were to be allowed to expire, thousands of
veterans and their families will find themselves with nowhere to go, except back
to the streets. AMVETS believes that if we are to realize the goal of ending
homelessness among the population of men and women who have so selflessly served
our great nation, we must pass this piece of legislation to ensure the
continuance of the enhanced lease program. Again, AMVETS supports the ‘‘Veterans
Health Care Facilities Capital Improvement Act of 2011’’ of legislation and
urges its quick passage.

Finally, AMVETS supports draft legislation, the “Honey Sue Newby Spina Bifida
Attendant Care Act”, to amend title 38, United States Code, to authorize the
Secretary of Veterans Affairs to provide assisted living services to certain
children of Vietnam veterans who are suffering from Spina bifida.

Chairwoman Buerkle and distinguished Members of the Subcommittee, AMVETS
would again like to thank you for inviting us to share with you our opinions and
recommendations on these very important pieces of legislation. This concludes my
testimony and I stand ready to answer any questions you may have for me.

Chairwoman Buerkle, Ranking Member Michaud, and distinguished Members of the
Subcommittee:

Thank you for inviting me here today to present the Administration’s views on
H.R. 198, the Veterans Dog Training Therapy Act; H.R. 1154, the Veterans Equal
Treatment for Service Dogs Act (VETS Dogs Act); H.R. 1855, the Veterans’
Traumatic Brain Injury Rehabilitative Services’ Improvements Act of 2011; H.R.
2074, the Veterans Sexual Assault Prevention Act; and H.R. 2530, a bill to
increase flexibility in establishing rates for reimbursement of State Homes.
Joining me today are Jim Sullivan, Director of the Office of Asset Enterprise
Management; Jane Clare Joyner, Deputy Assistant General Counsel; and Charlma
Quarles, Deputy Assistant General Counsel. We have not had sufficient time
to develop official views and estimates regarding the draft Honey Sue Newby
Spina Bifida Attendant Care Act or section 9 of the draft Veterans Health Care
Facilities Capital Improvement Act of 2011. We will forward the views and
estimated costs on these items to you as soon as they are available.

H.R. 198 ‘‘Veterans Dog Training Therapy Act’’

H.R. 198 would require the Secretary, within 120 days of enactment, to carry
out a pilot program to assess the effectiveness of addressing post-deployment
mental health and post-traumatic stress disorder (PTSD) symptoms of Veterans
through a therapeutic medium of training service dogs for other Veterans with
disabilities. The bill would require the Secretary to conduct the pilot program
at a minimum of three but not more than five Department of Veterans Affairs (VA)
medical centers for a 5 year period. Veterans diagnosed with PTSD or other
post-deployment mental health conditions would be eligible to volunteer to
participate. The bill requires that the VA medical centers selected as program
sites have available the following resources: a dedicated space suitable for
grooming and training dogs indoors, classroom and office space, storage
capacity, other areas for periodic use of training dogs with wheelchairs and for
other exercises, outdoor exercise and toileting space for dogs, and the
provision of weekly field trips to train dogs in other environments. The pilot
program must be administered under the direction of a certified recreational
therapist, and the Secretary would be required to establish a Director of
Service Dog Training with specific experience such as experience in teaching
others to train service dogs in a vocational setting, to oversee the training of
service dogs at selected VA medical facilities. Each pilot site would also be
required to have certified service dog training instructors.

The bill also includes provisions concerning the service dogs themselves. The
bill requires VA to ensure that each service dog in training is purpose-bred for
this work with an adequate temperament and health clearance. Dogs in animal
shelters or foster homes are not to be overlooked as candidates, but only as
determined appropriate by VA. The Secretary must also ensure that each service
dog in training is taught all essential commands required of service dogs, that
the service dog in training lives at the pilot program site or at a volunteer
foster home while receiving training, that the pilot programs include both
lecture of service dog training methodologies and practical hands-on training
and grooming of service dogs, and that the programs are designed to maximize the
therapeutic benefit of the Veterans participating in the program and to produce
well-trained service dogs for Veterans with disabilities. The Secretary would be
required to give hiring preference for service dog training instructor positions
to Veterans who have successfully graduated from PTSD or other residential
treatment programs and who have received adequate certification in service dog
training.

VA would be required to collect data on the pilot program and determine its
effectiveness for the Veteran participants. Specifically, under this bill, VA
must consider whether the pilot program effectively reduces the stigma
associated with PTSD or other post-deployment mental health conditions, improves
emotional regulation or patience, instills or re-establishes a sense of purpose
among participants, provides an opportunity to help fellow Veterans, facilitates
community reintegration, exposes service dogs to new environments in order to
help Veterans reduce social isolation and withdrawal, builds relationship
skills, relaxes the hyper-vigilant survival state, improves sleep patterns, and
enables Veterans to decrease the use of pain medication. VA would be required to
submit an annual report to Congress following the end of the first year of the
pilot program and each year thereafter to inform Congress about the details of
the program and its effectiveness in specific areas.

VA recognizes the therapeutic value to Veterans diagnosed with PTSD of
training service dogs for persons with disabilities; however, VA cannot support
H.R. 198.

VA has used Animal Assisted Therapy, or Animal Facilitated Therapy, for many
years as part of VA’s comprehensive approach to health care. VA is currently
utilizing therapy dogs as a component of treatment in a number of facilities and
settings, including VA’s Community Living Centers, palliative care units, and
most recently in recovery treatment programs. In July 2008, a Service Dog
Training Program was established as a therapy component at the Palo Alto
Veterans Healthcare System (Menlo Park Division), in collaboration with Bergin
University. Patients who have been diagnosed with PTSD and assigned to the Men
and Women’s Trauma Recovery Program have the option to participate in the
training of service dogs as one of their activities in their comprehensive
recovery program. This training focuses on basic obedience (e.g., commands such
as “sit,” “stay,” and “heel”) and public access skills (sensitizing dogs to
different environments) to prepare the dogs to become service dogs for persons
with mobility impairments. Initial patient self-reports and informal
observations by staff have been positive, and VA staff members have indicated
that the training of dogs, in combination with established recovery therapies,
is showing promise.

H.R. 198 imposes specific requirements that focus on the training of service
dogs. The bill is very prescriptive as to the requirements of the proposed pilot
program (e.g., staffing guidelines), and it would require evaluation of a large
and very detailed list of factors, many of which cannot be measured with any
degree of specificity or reliability. We are available to work with the
Committee to design a workable program and an appropriate mechanism to evaluate
whether training service dogs is a clinically appropriate form of treatment.

VA estimates the total cost for this bill would be $2 million in the first
year of the program and $10 million over 5 years.

H.R. 1154 would prohibit the Secretary from excluding service dogs from any
VA facilities or property or any facilities or property that receive funding
from VA.

VA acknowledges that trained service dogs can have a significant role in
maintaining functionality and promoting maximum independence of Veterans with
disabilities. VA recognizes the need for persons with disabilities to be
accompanied by their trained service dogs on VA properties consistent with the
same terms and conditions, and subject to the same regulations as generally
govern the admission of members of the public to the property. However, H.R.
1154 is unnecessary.

Under existing statutory authority in 38 U.S.C. § 901, VA can implement
national policy for all VA properties, and in fact did so for VHA facilities and
property on March 10, 2011 (VHA Directive 2011-013), directing that both
Veterans and members of the public with disabilities who require the assistance
of a trained guide dog or trained service dog be authorized to enter VHA
facilities and property accompanied by their trained guide dog or trained
service dog consistent with the same terms and conditions, and subject to the
same regulations that govern the admission of members of the public to the
property. We would be glad to provide a copy of the Directive for the record.
This Directive requires each Veterans Integrated Service Network (VISN) Director
to ensure all VHA facilities have a written policy on access for guide and
service dogs meeting the requirements of the national policy by June 30, 2011,
and VA is reviewing these policies to ensure their compliance with national
standards. In addition, VA intends to initiate rulemaking that will
establish criteria for service dog access to all VA facilities and property in a
manner consistent with the same terms and conditions, and subject to the same
regulations, as generally govern the admission of members of the public to the
property while maintaining a safe environment for patients, employees, visitors,
and service dogs.

H.R. 1154 would prohibit the Secretary from excluding service dogs from any
facility or on any property that receives funding from the Secretary. Such a
prohibition is unnecessary because it duplicates other statutes discussed below.

Any non-VA facilities and properties with which H.R. 1154 is concerned that
are also owned or controlled by the Federal government must under current law at
40 U.S.C.

§ 3103, admit on the same terms and conditions, and subject to the same
regulations, as generally govern the admission of the public to the property,
specially trained and educated guide dogs or other service animals accompanying
individuals with disabilities. Other non-VA properties not otherwise owned or
controlled by the Federal government, including but not limited to professional
offices of health care providers, hospitals, and other service establishments,
will almost certainly meet the definition of a place of public accommodation or
public entity under the Americans with Disabilities Act of 1990 as prescribed in
regulations at 28 C.F.R. §§ 35.104 and 36.104, and therefore be required to
modify their policies, practices, or procedures to permit the use of a service
animal by an individual with a disability in accordance with 28 C.F.R. §§ 35.136
and 36.302. We would note that VA facilities are not subject to the Americans
with Disabilities Act of 1990, but are subject to the Rehabilitation Act. The
Rehabilitation Act does not specifically address the issue of service dogs in
buildings or on property owned or controlled by the Federal government, but does
prohibit discrimination against individuals with disabilities, including those
who use service animals, in Federally- funded or -conducted programs and
activities. In addition, as explained above, there are other existing
authorities that address the issue of bringing guide dogs and other service
animals onto VA property.

VA estimates that there would be no costs associated with implementing this
bill.

In 2008, Congress established several programs targeted at the comprehensive
rehabilitation of Veterans and members of the Armed Services receiving VA care
and services for Traumatic Brain Injuries (TBI). In general, H.R. 1855 seeks to
improve those programs (established by 38 U.S.C. §§1710C-E) by requiring
rehabilitative services, as defined by the bill and discussed below, to be an
integral component of those ongoing programs. With one exception, we have no
objection to H.R. 1855.

Currently, the provisions of 38 U.S.C. § 1710C set forth the requirements for
an individualized rehabilitation and reintegration plan that must be developed
for each Veteran or member of the Armed Forces receiving VA inpatient or
outpatient rehabilitative hospital care or medical services for a TBI. VA
Handbook 1172.04, Physical Medicine and Rehabilitation Individualized
Rehabilitation and Community Reintegration Care Plan, implements section
1710C.

Section 2(a) of H.R. 1855 would amend some of the mandated requirements in
section 1710C. Specifically, it would clarify that the goal of each
individualized plan is to maximize the individual’s independence and quality of
life. It would also require, as part of a plan’s stated rehabilitative
objectives, the sustaining of improvements made in the areas of physical,
cognitive, and vocational functioning. Section 2(a) of the bill would further
require that each such plan include rehabilitation objectives for improving and
sustaining improvements in the individual’s behavioral functioning as well as
mental health.

These amendments would not alter VA’s policy or operations in any significant
way, as VA’s primary aim for Veterans with serious or severe injuries has always
been, and continues to be, maximizing their independence, health, and quality of
life. It is out of these concerns that VA has developed robust rehabilitation
therapy programs to help them learn or re-learn skills and develop resources for
sustaining gains made in their rehabilitation.

Section 2(a) of the bill would require the individual plans to include
access, as warranted, to all appropriate rehabilitative services of the
TBI continuum of care. The law now requires these plans to provide access, as
warranted, to rehabilitative
components of the TBI continuum of care (which includes, as appropriate,
access to long-term care services).

Current law also requires that each individualized plan include a description
of the specific “rehabilitation treatments and other services” needed to achieve
the patient’s rehabilitation and reintegration goals. Section 2(a) of the bill
would replace all references to “treatments” in the affected provision with
“services.” This would ostensibly broaden the scope of rehabilitative
benefits available to these patients beyond what is deemed to be treatment
per se.

It would also add to each plan the specific objective of improving (and
sustaining improvements in) the patient’s behavioral functioning. That addition,
together with the existing rehabilitation objective to improve a patient’s
cognitive functioning, would effectively encompass all relevant mental health
issues related to TBI. For that reason, we believe the bill’s other amendment to
separately include a rehabilitation objective for improving “mental health”
would create confusion or redundancy. We thus recommend that language be
deleted.

Most notably, Section 2(a) of H.R. 1855 would establish a new definition of
the term “rehabilitative services,” for purposes of all of VA’s specially
targeted, statutory programs for TBI patients (i.e., 38 U.S.C. §§ 1710C-E). Such
services would include not only those that fall under the current statutory
definition found in 38 U.S.C. § 1701 but also “services (which may be of ongoing
duration) to sustain, and prevent loss of, functional gains that have been
achieved.” In addition, they would include "any other services or supports that
may contribute to maximizing an individual's independence and quality of life.”
This last definition is overly broad and could be read to include services or
items well beyond the field of health care. It is also unworkable. What
maximizes an individual’s “quality of life” is highly subjective and, as such,
the term defies consistent interpretation and application. We believe enactment
of that last provision of the proposed new definition would conflict with and
exceed our primary statutory mission, which is to provide medical and hospital
care. It should therefore be deleted, leaving only the first two prongs of the
definition.

Next, as briefly alluded to above, the individualized rehabilitation and
reintegration plans required by section 1710C must include access, where
appropriate, to long-term care services. The eligibility and other requirements
of VA’s mandated comprehensive program of long-term care for the rehabilitation
of post-acute TBI are found in 38 U.S.C. § 1710D. Section 2(b) of H.R. 1855
would require the Secretary to include rehabilitative services (as that term
would be defined by Section 2(a) of the bill) in the comprehensive program. It
would also eliminate the word “treatment” in the description of the
interdisciplinary teams to be used in carrying out that program. We have no
objection to this proposed revision.

Lastly, Congress authorized VA, under specified circumstances, to furnish
hospital care and medical services required by an individualized rehabilitation
and reintegration plan through a cooperative agreement. (A cooperative agreement
may be entered only with an appropriate public or private entity that has
established long-term neurobehavioral rehabilitation and recovery programs.)
This authority is found at 38 U.S.C. § 1710E. Section 2(c) of H.R. 1855
would add “rehabilitative services” (again as defined by Section 2(a) of the
bill) to the types of services that may be provided under those agreements. We
have no objection to this proposed revision.

Finally, we note as a technical matter that there is a typographical error in
the spelling of “ophthalmologist” in Section 1710C(c)(2)(S) of title 38, U.S.C.
Additionally, current law permits inclusion of “educational therapists” among
the TBI experts responsible for conducting comprehensive assessments of these
patients. (These assessments are then used to design the individualized plans
discussed above.) However, this categorization of professionals is no longer
used in the field of medical rehabilitation.

We do not otherwise object to H.R. 1855. No new costs would be associated
with its enactment.

H.R. 2074 “Veterans Sexual Assault Prevention Act”

H.R. 2074 would amend title 38, United States Code, by adding a new section
1709 known as the “Veterans Sexual Assault Prevention Act.” Section 1709 would
require VA to “develop and implement a centralized and comprehensive policy on
the reporting and tracking of sexual assault incidents and other safety
incidents that occur” at VA medical facilities including incidents of sexual
assault, criminal and purposeful unsafe acts, alcohol or substance abuse related
acts, and acts involving abuse of a patient. VA would need to develop and
implement this policy by October 1, 2011. In addition, Section 1709(d) would
require VA to submit an annual report to Congress discussing implementation and
effectiveness of the policy.

VA considers the safety and security of our Veterans, employees and visitors
to be among our highest priorities. We take all allegations seriously and
investigate them thoroughly.

In response to a recent Government Accountability Office (GAO) report
(GAO-11-530) entitled “VA Health Care: Actions Needed to Prevent Sexual
Assaults and Other Safety Incidents,” VA has convened an interdisciplinary
Safety/Security Workgroup including representatives from VHA and VA corporate
offices, including the Office of Operations, Security and Preparedness (OSP) and
the Office of General Counsel. VA has charged the Safety/Security
Workgroup to define steps necessary to ensure VA is taking every action required
to respond effectively to reports of sexual victimization of Veterans,
employees, and visitors. The Workgroup is developing appropriate proactive
interventions to reduce the risk of these events, testing a computerized
reporting system for ongoing data tracking and trending, and is currently
establishing guidance for training of staff and providers. Initial action plans
from the Workgroup have been submitted, with a final written report to be
completed by September 30, 2011. The Workgroup’s Chairs provide weekly updates
to VA’s Under Secretary for Health, ensuring that leadership is aware of the
progress being made and can intervene to continue our efforts to improve
facility safety.

We believe H.R. 2074 is unnecessary because our current efforts are
fulfilling much of what it would require. In addition to the Workgroup, VA is
already undertaking other efforts to enhance the safety and security of our
facilities. For example, VA is evaluating its risk assessment tools and is
developing enterprise-wide assessments that consider issues beyond the Veteran’s
legal history and medical record. VA is taking steps to consider universal risk
for violence and design appropriate intervention actions. These are important
steps to improve evaluations of patient risk. Mandatory training on security
issues is also in development, and VA plans to provide educational materials for
patients and visitors as well so they can help contribute to a safer VA
environment for everyone. VA’s Integrated Operations Center (IOC), established
in 2009, provides oversight of VA facilities 24 hours a day, 7 days a week and
is responsible for collecting any reports of serious incidents, including
alleged criminal behavior at VA facilities. VHA is already developing an
oversight system like that described in the bill. It will be in place later this
summer, and will have clear and consistent guidance on the management and
treatment of sexual assaults by the end of 2011.

While we agree with many of the aims of H.R. 2074, and are proceeding with
similar initiatives, we do have several concerns with the bill as written.
First, the timeline for the implementation of this policy is not feasible. VA is
committed to enacting this policy, but needs time to complete work on reporting
tools and processes and to pilot these initiatives before the policy will be
fully implemented so that we can achieve the shared goal of increased safety.
Second, VA is concerned that the term “other safety incidents” is overly broad.
While the bill requires VA to define the term “safety incident” and provides the
Secretary the authority to prescribe regulations to implement the legislation,
“other safety incidents” could be read broadly to include any safety incident,
including workplace issues (such as a slip and fall situation) and occupational
safety concerns. VA believes the intent of this provision is to focus on the
security of patients, employees and visitors, and we will define this term
accordingly. We are happy to work with the Committee to refine this language in
the legislation.

VA also has serious concerns with the requirement that VA report “alcohol or
substance abuse related acts” committed by Veterans. VA is an integrated health
care system that treats all of the health care needs of Veterans, including
substance use disorders and alcoholism. With our focus on universal precautions,
we will assess all potential risks, not just those associated with substance use
disorders. Alcohol and drug misuse are associated with a host of medical,
social, mental health, and employment problems. Fortunately, these problems are
treatable and with treatment, the lives of our patients and their loved ones can
be enriched. VA does not want to create a disincentive for Veterans to seek
treatment for these conditions and recommends that this provision be deleted
from the bill.

Since VA is already making significant improvements in our tracking and
reporting system that meet or exceed the requirements of the legislation, we
estimate that this bill would result in no additional costs. We appreciated the
opportunity to discuss this issue and hear your recommendations on June 13. We
are happy to meet with the Committee to discuss this issue in more detail.

H.R. 2530 Increased Flexibility in Rates of Reimbursement for State Homes

H.R. 2530 would require State homes and VA to contract, or enter into a
provider agreement under 38 U.S.C. § 1720(c)(1)(A), for the purpose of providing
nursing home care in these homes to Veterans who need it for a service-connected
condition or have a service-connected rating of 70 percent or greater.
This payment methodology would replace the current per diem grant payments for
these Veterans which were implemented in 2009. VA supports this provision
in principle as subsection (a)(1) is consistent with section 104 of VA’s draft
bill “Veterans Health Care Act of 2011,” which was transmitted to Congress on
June 7, 2011.

We do have technical concerns with how the bill would treat provider
agreements, as distinguished from arrangements with State Veterans Homes on a
contract basis. The requirement in subsection (a)(2) that payments under
each provider agreement be based on a methodology developed by VA in
consultation with the State home would prevent VA from using provider agreements
with State homes. The authority for using provider agreements in 38 U.S.C.
§ 1720(c)(1)(A) essentially authorizes VA to enter into agreements like the
Centers for Medicare and Medicaid Services (CMS) does under the Medicare program
without entering into contracts. There are no procedures for negotiating
rates of payments under the Medicare program. This facilitates entering
into these agreements. If H.R. 2530 were enacted and negotiations are required
under this authority, VA would only be able to contract. We are happy to work
with the Committee to refine this language in the legislation.

VA estimates that there would be no additional costs associated with H.R.
2530.

H.R. _____, the “Veterans Health Care Facilities Capital Improvement Act of
2011”, would authorize certain Department of Veterans Affairs major medical
facility projects and leases, extend certain expiring provisions of law, and
modify certain other authorities. Specifically, this bill would provide
authorization for major medical facility construction projects and major medical
facility leases, all of which are consistent with projects and leases requested
in Department of Veterans Affairs’ draft construction authorization bill.

Section 2 would authorize construction of a project for seismic corrections
for Building 100 in Seattle, Washington, in an amount not to exceed $51,800,000.
Also authorized is a project for construction of seismic corrections and
renovation of various buildings, the initial phase of which is Building 209 for
housing facilities for homeless Veterans in West Los Angeles, California, in an
amount not to exceed $35,500,000.

Section 3 would modify the authorization of five major medical facility
construction projects. The authorization of the Veterans Affairs Medical Center
in Fayetteville, Arkansas, would be modified to include a parking garage. The
total amount for this project is $90,600,000. The previous extension of
authorization for the project at the Veterans Affairs Medical Center in Orlando,
Florida is modified to include a Simulation, Learning, Education and Research
Network Center. The amount of the previously authorized project for the project
at the Veterans Affairs Medical Center in Palo Alto, California, is increased to
$716,600,000. The amount of the previously authorized project at the
Veterans Affairs Medical Center in San Juan, Puerto Rico, is increased to
$277,000,000. The amount of the previously authorized project at the Veterans
Affairs Medical Center in St. Louis, Missouri, is increased to $346,300,000.

Section 4 would authorize the Secretary to carry out eight major medical
facility leases, all of which were included in VA’s draft construction bill.
Specifically, Section 4 would authorize the Secretary to carry out major medical
facility leases for a community-based outpatient clinic in Columbus, Georgia, in
an amount not to exceed $5,335,000; an outpatient clinic in Fort Wayne, Indiana,
in an amount not to exceed $2,845,000; an outpatient clinic in Mobile, Alabama,
in an amount not to exceed $6,565,000; an outpatient clinic in Rochester, New
York, in an amount not to exceed $9,232,000; a community-based Outpatient Clinic
in Salem, Oregon, in an amount not to exceed $2,549,000; an outpatient clinic in
San Jose, California, in an amount not to exceed $9,546,000; an outpatient
clinic in South Bend, Indiana, in an amount not to exceed $6,731,000; and, a
community-based outpatient clinic in Springfield, Missouri, in an amount not to
exceed $6,489,000.

Section 5 would authorize appropriations for the projects and leases listed
in Sections 2, 3 and 4, subject to certain limitations. With the exception of
Section 5(b), this section is consistent with the Department of Veterans Affairs
draft construction authorization bill. Section 5(b) indicates that $850,070,000
is authorized to be appropriated for certain major medical facility projects
that were previously authorized. However, we believe the correct amount to be
authorized for Section 5(b) is $914,507,000.

Section 6 would make certain amendments to VA’s enhanced-use lease (EUL)
authority, including granting a much-needed 10-year extension to the current
legislation, before it expires at the end of this calendar year. Section 6 of
the draft bill would also allow the Secretary to consider proposed EUL business
plans by other organizations within the Department, as opposed to just VA’s
Veterans Health Administration. Third, the draft bill would incorporate certain
business parameters to ensure EUL compliance with the latest capital scoring
rules and guidelines. Fourth, it would allow the Department to deposit and use
future EUL proceeds as part of the agency’s major and minor construction
accounts. And fifth, the draft bill would add clarifying language to
emphasize that the Federal government’s underlying real property ownership, and
leaseback of any lands through EULs are exempt from State and local taxes, fees,
and assessments. I would like to thank the Subcommittee for addressing VA’s EUL
authority extension in the Veterans Health Care Facilities Capital Improvement
Act of 2011.

The EUL authority was enacted in August 1991, and is codified in sections
8161 through 8169 of title 38 of the U.S. Code. In 2001, the authority was
renewed for an additional 10 years through the end of 2011. The Department’s
authority to enter into additional EUL agreements will expire on December 31,
2011. Without a reinstatement of the EUL authority, VA will no longer have the
mechanism in place to acquire third-party investment for new facilities, space,
services or revenue to serve Veterans.

The EUL authority allows VA to outlease land and improvements under the
department’s jurisdiction or control, to public or private sector entities for
up to 75 years. In return, VA receives negotiated monetary and/or in-kind
consideration. The outleased property is developed, used, and maintained for
agreed-upon uses that directly or indirectly support VA’s mission.

EULs have provided a variety of benefits such as enhanced services to
Veterans, operations and maintenance cost savings, private investment, new
long-term revenue for VA, job creation, and additional tax revenues for local,
State and Federal sectors. In some instances, EULs have helped VA meet its
environmental goals by creating on-site renewable energy facilities enabling VA
to reduce its greenhouse gas emissions.

Since the original EUL legislation passed in August 1991, more than 60
projects have been awarded–18 of these for housing providing 1,066 housing units
benefiting Veterans. From FY 2006 to 2010, EULs have generated approximately
$266 in total consideration.

In terms of Veterans housing, EUL provides multiple benefits: helping to
reduce homelessness among our Veterans while leveraging underutilized assets,
reducing the inventory of underutilized real estate, and transferring the
operation and maintenance costs to the developers – while maintaining VA control
of the underlying assets.

Currently, VA has 19 EUL projects underway to provide nearly 2,200 units of
housing for homeless Veterans and their families; and approximately 600 units of
assisted living and senior housing, which will be curtailed if VA’s EUL
authority is not extended.

Additionally, if VA’s EUL authority is not extended, it will halt another 34
housing projects under VA’s Building Utilization Review and Reuse
(BURR) Initiative, which involves approximately 1,700 units of housing for
homeless Veterans, and 900 units of senior, non-senior independent living, and
assisted living housing for Veterans.

Congressional approval of VA’s EUL authority extension is critical for VA to
continue the successful efforts to facilitate the provision of homeless housing
for Veterans and their families through public/private ventures. EUL is a
valuable tool used by the Secretary in VA’s multi-faceted approach to eliminate
Veteran homelessness. If the EUL authority is not extended, a total of 5,500
housing units for homeless Veterans and Veterans at-risk-for homelessness will
be affected.

Section 7 of the Act would modify the requirements relating to Congressional
approval of certain medical facility acquisitions. Specifically, the Secretary
would be required to submit additional information in the prospectus for each
major construction facility. We do not object to these modifications.

Section 8 would designate the Department of Veterans Affairs telehealth
clinic in Craig, Colorado as the “Major William Edward Adams Department of
Veterans Affairs.” The Department has no objection to this proposal and defers
to Congress in the naming of Federal property.

Section 9 would extend certain expiring authorities. Subsection (a) of
section 9 would amend 38 U.S.C. § 1703 to extend the recovery audit program for
fee basis and other medical service contracts until September 30, 2020.
This authority is currently set to expire on September 30, 2013.

Subsection (c) would amend 38 U.S.C. § 2033 to extend until December 31,
2018, VA's authority to expand and improve benefits to homeless Veterans. Title
38 U.S.C. § 2033 authorizes VA, subject to appropriations, to operate a program
to expand and improve the provision of benefits and services to homeless
Veterans. The program includes establishing sites under VA jurisdiction to be
centers for the provision of comprehensive services to homeless Veterans in at
least each of the 20 largest metropolitan statistical areas. This
authority is currently set to expire on December 31, 2011.

Subsection (d) would amend 38 U.S.C. § 2041(c) to extend, through December
31, 2018, the Secretary’s authority to enter into agreements with homeless
providers for the purpose of selling, leasing, or donating homes acquired
through the guaranteed loan program. This authority is currently set to
expire on December 31, 2011.

Subsection (e) would amend 38 U.S.C. § 2066 to extend Congressional authority
to continue the Advisory Committee for Homeless Veterans until December 31,
2018. This authority is currently set to expire on December 30, 2011.

Subsection (f) would amend 38 U.S.C. § 8118(a)(5) to extend until December
31, 2018, the Secretary of VA's authority to transfer real properties under his
jurisdiction and control, to other Federal agencies, State agencies, public or
private entities, or Indian tribes. This authority is currently set to expire on
December 31, 2011.

While VA requested extensions of sections 2031, 2033, 2041 and 2066 of title
38, U.S.C. in our draft bills the “Veterans Health Care Act of 2011” and
“Veterans Benefit Programs Improvement Act of 2011,” which were transmitted to
Congress on June 7 and May 19, 2011, the draft “Veterans Health Care Facilities
Capital Improvement Act of 2011” would extend these authorities for a
considerably longer period of time. VA requires additional time to
evaluate these provisions and we will provide views and costs on this section
for the record.

This concludes my prepared statement. Thank you for the opportunity to
testify before the Subcommittee. I would be pleased to respond to any questions
you or Members of the Subcommittee may have.

Statement of Fred S. Sganga,
President, National Association of State Veterans Homes

I. Overview

The National Association of State Veterans Homes (“NASVH”) appreciates the
opportunity to submit this statement on H.R. 2530, sponsored by Mr. Michaud and
Chairman Miller. The bill will provide for increased flexibility in establishing
rates of reimbursement for State Veterans Homes by the Secretary of Veterans
Affairs for nursing home care provided to service-connected disabled veterans.
The text of H.R. 2530 is identical to legislative language approved by the
Senate Committee on Veterans’ Affairs on June 29, 2011, as section 109 of S.
914.

H.R. 2530 is intended to remedy the consequences of the implementation of
section 211(a) of the Veterans Benefits, Health Care, and Information Technology
Act of 2006 (Pub. L. No. 109-461) (the “2006 Act”). Section 211(a) of the 2006
Act established new payment mechanisms by the VA for the long-term care of
service-connected disabled veterans at State Veterans Homes (the “70 Percent
Program”). NASVH believes that the 70 Percent Program must be remedied promptly
by legislation. Continuation of the 70 Percent Program in its current form will
not only inhibit the long-term care of service-connected disabled veterans, but
will also threaten the financial viability of many of the Nation’s State
Veterans Homes.

NASVH’s membership consists of the administrators and staff of State-operated
Veterans Homes throughout the United States and in the Commonwealth of Puerto
Rico. NASVH members currently operate 142 Veterans Homes in all 50 States and
Puerto Rico. Our nursing homes provide over 29,000 nursing home and domiciliary
beds for veterans and their spouses, and for the gold-star parents of veterans.
Our nursing homes assist the VA by providing long-term care services for
approximately 53 percent of the VA’s long-term care workload at the very
reasonable cost of only about 12 percent of the VA’s long-term care budget. On
average, the daily cost of care of a veteran at a State Veterans Home is less
than 50 percent of the cost of care at a VA long-term care facility.

Particularly in these times of tight Federal budgets and deficit reduction
imperatives, the national State Veterans Home system is an economical
alternative to other VA long-term care programs. In fact, a report by the VA’s
Office of Inspector General stated:

A growing portion of the aging and infirm veteran population requires
domiciliary and nursing home care. The SVH [State Veterans Home] option has
become increasingly necessary in the era of VAMC [VA Medical Center] downsizing
and the increasing need to discharge long-term care patients to community based
facilities. VA’s contribution to SVH per diem rates, which does not exceed 50
percent of the cost to treat patients, is significantly less than the cost of
care in VA and community facilities.

II. Inadequacies of the Current 70 Percent Program

Implementation of the 70 Percent Program has created very serious unintended
consequences for State Veterans Homes throughout the country. The 70 Percent
Program authorized payment of different per diem amounts by the VA to State
Veterans Homes which provide nursing home care to veterans with
service-connected disabilities. Although the 2006 Act creating the 70 Percent
Program became effective on March 31, 2007, the VA did not issue regulations to
implement the 70 Percent Program until April 29, 2009, and problems arose
immediately with its implementation. Since that time, NASVH has met repeatedly
with VA officials in an attempt to modify the 70 Percent Program
administratively to solve these problems, but both NASVH and the VA now agree
that some of the problems with the 70 Percent Program can only be solved fully
by a modification of the law.

The problems with the 70 Percent Program are as follows. Although VA
regulations implementing the 70 Percent Program state that the Program provides
a “higher
per diem rate” for veterans with service-connected disabilities, the regulations
actually result in significantly lower total amounts being paid to many
State Veterans Homes providing “skilled nursing care” to veterans with
service-connected disabilities. In fact, the 70 Percent Program, in its current
form, substantially underpays State Veterans Homes for “skilled nursing care,”
and pays State Veterans Homes only about 1/2 to 2/3 of what Medicare previously
paid to State Veterans Homes for the same care of the same veterans, and only
about 1/3 to 1/2 of what the VA currently pays itself for the same care of the
same veterans with service-connected disabilities.

“Skilled nursing care” is relatively common nursing care that involves
significant amounts of rehabilitative services such as physical therapy,
occupational therapy, speech therapy, expensive pharmaceuticals, and specialty
medical services that often are not easily accessible at a nearby VA Medical
Center by a State Veterans Home. As implemented, the 70 Percent Program does not
provide to many State Veterans Homes their total cost of “skilled nursing care”
for service-connected disabled veterans, despite Congressional intent. This is a
problem largely for those 34 States that have Medicare-certified State Veterans
Homes and that provide a substantial amount of skilled nursing care to veterans
with service-connected disabilities. The number of States that have
Medicare-certified State Veterans Homes that provide “skilled nursing care” is
steadily increasing.

The 70 Percent Program’s inadequate reimbursement levels have caused many
State Veterans Homes that provide a substantial amount of skilled nursing care
to veterans simply not to admit veterans to their State Veterans Homes under the
70 Percent Program, to limit the numbers of such admissions, or to admit
veterans under the 70 Percent Program without restriction and expose themselves
to substantial financial losses. This is exactly the opposite result sought by
Congress when it passed the 2006 Act. In short, although the current 70 Percent
Program is workable for some State Veterans Homes which provide largely
non-skilled nursing care to veterans with service-connected disabilities, it
causes substantial problems for an increasing majority of States in the Nation
which provide substantial amounts of skilled nursing care to such veterans in
State Veterans Homes. As such, the 70 Percent Program is not achieving its
central intended purposes, and it must be corrected.

In addition, because of a quirk in the existing 70 Percent Program law,
almost no State Veterans Home in the Nation actually is paid the “higher”
prevailing per diem rate established by the VA for the 70 Percent Program. This
is so because a combination of 38 U.S.C. §1745 and the VA regulations
implementing §1745 require that State Veterans Homes be paid only “the lesser
of” the per diem rate established by the VA for the 70 Percent Program or a
rate determined under OMB Form A-87. The OMB Form A-87 rate is almost always
significantly less than the prevailing per diem rate published by the VA for the
70 Percent Program, and this has caused an additional financial hardship for
State Veterans Homes.

Lastly, the most regrettable unintended consequence of the 70 Percent Program
is that, for service-connected disabled veterans, it unnecessarily replaced a
program (under 38 U.S.C. § 1741) that had worked well for decades for the States
that have Medicare-certified State Veterans Homes with a program (under 38
U.S.C. § 1745) that has a multitude of regulatory and financial problems.

III. The Remedy Proposed by H.R. 2530

NASVH has been working with the VA since the 70 Percent Program regulations
were implemented in 2009 to resolve these difficulties. Although reluctant to
overhaul the program initially, the VA now has recognized the need for
substantial changes. The VA transferred administrative responsibility for
the financial aspects of the 70 Percent Program from the VA Office of Geriatrics
and Extended Care to the VA Chief Business Office. NASVH has met several times
with senior officials at the Chief Business Office and we are confident that
they are sincerely trying to solve the problems of the 70 Percent program.

Most recently, the VA and its Chief Business Office have proposed to amend
the current 70 Percent Program statutory language under 38 U.S.C. § 1745 to
authorize the VA to enter into direct contracts with State Veterans Homes under
38 U.S.C. § 1720 that could adequately and accurately reimburse State Veterans
Homes for providing long-term care to 70 Percent Program veterans. This is, in
essence, the remedy proposed by H.R. 2530. However, this solution will work
effectively only if it is implemented fairly by the VA, taking into account the
following considerations.

First, as stated above, NASVH is working with the VA Chief Business Office to
develop adequate and accurate reimbursement measures for the long-term care of
70 Percent Program veterans. The most equitable approach appears to be to
establish that payments by the VA for basic long-term care under section
1720 contracts be comparable to the existing “higher” prevailing per diem rate
established by 38 U.S.C. § 1745. This is a mechanism that will work effectively
to reimburse State Veterans Homes for the basic nursing care of
service-connected disabled veterans.

Second, any payment program implemented by the VA should require that
payments by the VA for “outlier” specialty medical services and drugs provided
to veterans by State Veterans Homes under a section 1720 contract be made at
rates and under eligibility criteria comparable to those used by Medicare.
Rather than leave the determination of the reimbursement levels for such
services provided to service-connected disabled veterans to the whims or annual
changes in VA policy or personnel, Medicare payment levels and eligibility
criteria can serve as constant and fair guidance for any VA program to reimburse
State Veterans Homes for “outlier” specialty medical services and drugs under
section 1720 contracts for the long-term care of service-connected disabled
veterans.

Third, we emphasize that a contract is a two-sided instrument. Both sides
must agree for a contract to exist. The ability of a State Veterans Home to
enter into a contract with the VA for the long-term care of a service-connected
disabled veteran means necessarily that a State Veterans Home also has the
option not
to enter into such a contract, if the State Veterans Home believes that the
reimbursement terms offered by the VA for the care of such a veteran are not
adequate. In short, the VA will succeed in having State Veterans Homes provide
significant amounts of nursing home care to service-connected disable veterans
only if the VA pays State Veterans Homes adequately for such care.

Lastly, it is important for the Subcommittee to realize that the enactment of
the above provisions should not cost the Federal government anything additional
and should, in fact, save the Federal government substantial amounts of money.
This is so because of the simple fact that enactment of the Bill’s proposals
described above will encourage more service-connected disabled veterans to
receive long-term care at State Veterans Homes rather than at VA long-term care
facilities, and State Veterans Homes cost far less on a per veteran per day
basis than VA long-term care facilities.

The cost differences are dramatic. The average cost per veteran per day at a
VA long-term care facility is $944.25 (VA, Volume II, Medical Programs and
Information Technology Programs, Congressional Submission, FY 2012 Funding and
FY 2013 Advance Appropriations Request, page 1H-19). Assuming enactment of the
proposals described above, the average cost per veteran per day at a State
Veterans Home, including basic care, drugs, and outlier specialty costs is not
likely to exceed $450.00 per day. Accordingly, every service-connected disabled
veteran that receives long-term care at a State Veterans Home rather than at a
VA long-term care facility will save the Federal government over $494 per day,
or $180,310 per veteran per year.

Nationally, there are 24,422 State Veterans Home nursing facility beds that
could be occupied by 70 Percent Program veterans. On the average, 13 percent of
these beds, or almost 3,175 beds, are unoccupied. Approximately 2,000 additional
State Veterans Home nursing facility beds that could be occupied by 70 Percent
Program veterans are under construction. Accordingly, if State Veterans Homes
were to fill only their currently vacant beds with 70 Percent Program veterans,
the Federal government would save approximately $5.7 billion over 10 years. If
only half of the vacant State Veterans Home long-term care beds were filled by
70 Percent Program veterans instead of such veterans receiving long-term care
services at VA long-term care facilities, the Federal government would save $2.8
billion over 10 years.

Currently, however, many State Veterans Homes, especially those providing
“skilled nursing care,” are discouraging the admission of service-connected
disabled veterans to their facilities because the payment structure under the
current 70 Percent Program is so inadequate. The solution to this is to pay
State Veterans Homes adequately and accurately to care for service-connected
disabled veterans. State Veterans Homes cost far less on a per veteran per day
basis than VA long-term care facilities. The VA should fully utilize a
less-costly resource (State Veterans Homes) before using a more-costly resource
(VA long-term care facilities). It is simply good business, and good veterans
health care policy, for the Chief Business Office of the VA to seek to reimburse
State Veterans Homes adequately for the long-term care of service-connected
disabled veterans.

NASVH thanks the Subcommittee for its continuing efforts to solve this
important problem, and we encourage the Members of the Subcommittee to favorably
report H.R. 2530. We look forward to continuing to work with the VA and Congress
to resolve these issues promptly so that we can better serve our Nation’s
veterans.

Statement of Rick A. Yount,
Director, Paws for Purple Hearts

Madam Chairwoman and Members of the Subcommittee, as the Founder and Director
of the Paws for Purple Hearts program, I would like to thank you for the
opportunity to submit a statement for the record in support of H.R. 198, the
Veterans Dog Training Therapy Act and H.R. 1154, the Veterans Equal Treatment
for Service Dogs Act. I am pleased that the Subcommittee is recognizing
the important roles that dogs are playing in helping to heal the physical and
psychological wounds of our Nation’s Veterans.

H.R. 198

Attached to this statement is an overview of the Paws for Purple Hearts (PPH)
program that inspired the introduction of H.R. 198, the Veterans Dog Training
Therapy Act. The program’s pilot was originally implemented at the Palo Alto VA
Trauma Recovery Program at Menlo Park commencing in July 2008. It has since
expanded to DoD medical facilities, including Walter Reed Army Medical Center
and the National Intrepid Center of Excellence for Psychological Health and
Traumatic Brain Injury. The provisions of H.R. 198 are based on the PPH program
developed at VA Menlo Park.

I created the PPH program based on my experience as a licensed social worker
and certified service dog instructor. The program was designed to provide
meaningful therapeutic activities based on the continued mission of caring for
the needs of a fellow Veteran. The training was developed to address all three
symptom clusters associated with post-traumatic stress disorder (PTSD). Since
beginning this therapeutic intervention model 3 years ago at VA Menlo Park, I
have witnessed amazing responses to this program from both active duty Service
Members involved in the current conflicts, as well as Vietnam Veterans who have
participated in the training of service dogs for their fellow Veterans. Many
accredited assistance dog organizations involve prisoners and at-risk teens in
the training of dogs to serve people with disabilities. When it comes to
training dogs for Veterans, no one takes that task more seriously than those who
served by their sides in conflict. Veterans who have experienced psychological
wounds never stray from the core value of caring for their fellow Veterans. This
warrior ethos serves as a powerful motivational tool to inspire Veterans with
psychological injuries, including PTSD, to voluntarily participate in the
training of service dogs for their comrades. After teaching hundreds of college
students and at-risk teens to train service dogs, I have found no one more
dedicated to the cause than the Warriors and Veterans I have worked with in the
PPH program.

Training a service dog for a fellow Veteran provides a valuable opportunity
for the Veteran trainer to reintegrate into civilian life. As part of the
training, the Veterans have the responsibility to teach the dogs that the world
is a safe place. Through that process, they must convince themselves of the
same. The Veteran trainers are taught to praise and treat the dogs when they
hear a car backfire or other startling events. Rather than turning inward to
ruminate on their past trauma, they must get outside of their own heads to focus
on the dogs and their mission to help another Veteran. Additionally, the dogs
act as social lubricants and offer opportunities to Veterans, who often isolate
themselves from society, to experience positive interactions with members of the
community. The training requires the emotionally numb Veterans to use
demonstrative positive emotion in order to successfully teach their dogs.
Veterans participating in the program have reported that using positive emotions
to praise the dogs has significantly improved their family dynamics as their
children respond to this positive parenting strategy.

PPH offers a symbiotic opportunity to address the needs of two cohorts of
Veterans in one program. It is safe, available, cost-effective, and has earned
the respect of VA and DoD health care providers. In addition to the recognized
mental health benefits of the training, the quality of the service dogs that
result from that training was documented recently by the History Channel’s
“Modern Marvels” program dedicated to dogs. Venuto, the PPH dog that was
featured in the program, enhanced the mental health of 20+ Veterans with PTSD as
they participated in his training. Venuto was then successfully partnered with a
Veteran who is paraplegic as a result of a Spinal Cord Injury (SCI).

To substantially benefit over 20 Veterans with one dog allows the VA to
provide outreach to a greater number of Veterans without the logistical
challenges of providing a dog to each Veteran. Also, the Veteran trainers gain
valuable dog handling and care skills should they receive a service dog in the
future. As described in the attachment, the presence of the service dogs
in training at VA and DoD medical facilities also benefits other patients and
health care providers.

The positive clinical observations of the VA Menlo Park service dog training
program were formally presented during workshops at the VA National Mental
Health Conference and the International Society for Traumatic Stress Studies
Conference in 2009. I was joined by a Menlo Park VA Staff Psychologist and a
Recreational Therapist in making those presentations. The workshops inspired
significant interest from other VA Medical Centers in replicating the program at
their sites.

There is a great opportunity for collaboration between the VA and the DoD
with regard to the training, provision, and research associated with service
dogs. The Army Surgeon General held an Animal-Assisted Intervention Symposium in
December of 2009. The Army Family Act Plan of 2010 identified “providing service
dogs to Wounded Warriors” as the #2 priority out of 82 issues. The leadership at
the National Intrepid Center of Excellence (NICoE) for Psychological Health and
Traumatic Brain Injury under the Defense Centers of Excellence has embraced
service dog training as an intervention worthy of research. The VA could
simplify the task of collecting specified outcomes by partnering with the NICoE
to avoid duplication of effort and waste of resources.

The VA has questioned whether there is a substantial need for service dogs by
Veterans. This issue was addressed in a 2007 study published in the Psychosocial
Process Journal that indicated 42 percent of randomly selected Veterans with SCI
desired information concerning service dogs. The study determined that “Among
veterans with SCI there is a substantial interest in service dogs. Health care
providers have a responsibility for educating individuals with SCI about the
potential benefits and drawbacks of service dogs and for facilitating the
process of obtaining information from service dog training organizations.” The
study concluded that, “The VA could help support these organizations financially
or establish training centers of its own to increase the availability of trained
dogs in order to accomplish what Public Law 107-135 intended.”

The Department of Veterans Affairs is not currently providing any funding for
the service dog training therapy pilot program at VA Menlo Park, even though VA
officials have recognized the therapeutic value of the program. Private donors
provided the seed funding to demonstrate the efficacy of this intervention for
the symptoms of PTSD. Although the Secretary currently has the authority
to establish a VA funded Veterans service dog training pilot program, the
Department has resisted taking any financial responsibility for this promising
intervention. Consequently, enactment of H.R. 198 is necessary to sustain the VA
Menlo Park pilot program and to expand this model to other VA treatment
facilities.

H.R. 1154

I support the provisions of H.R. 1154, the Veterans Equal Treatment for
Service Dogs Act, because Veterans should be afforded the same rights at VA
facilities as other Americans are provided under the Americans with Disabilities
Act. Language needs to be included in the bill to ensure that service dogs in
training under the guidance of certified instructors associated with Veterans
Dog Training Therapy programs receive the same status as fully trained service
dogs for purposes of access to VA facilities.

Paws for Purple Hearts (PPH) is a dual-purpose program created to meet the
needs of Service Members and Veterans with physical and/or psychological
injuries. The approach uses the process of service-dog training to remediate
Post-Traumatic Stress symptoms in Service Members and Veterans. The trained dogs
are then placed with fellow Veterans who have mobility-limiting injuries.

Founded on the time-honored tradition of Veterans-helping-Veterans, PPH
enables Service Members and Veterans to actively provide support for their
fellow injured Service Members and regain a tangible sense of purpose. PPH is
currently being implemented at Department of Defense (DoD) and Veterans
Administration (VA) sites. Two hundred active duty and Veterans with PTSD have
participated in the program since it was first offered in 2008. Five
service-dogs trained by PPH instructors have been placed with Veterans.
Two Service Members have become accredited service dog-trainers and are pursuing
careers in this field.

The curriculum of the service-dog training program is specifically designed
to remediate the core-symptoms of post-traumatic stress, such as
re-experiencing, avoidance, and hyperarousal. Clinical experience to date
has been encouraging with respect to traumatic stress symptom and harm
reduction, a decrease in the need for pain and sleep medicine and improved
communication skills and sense of well-being.

PROGRAM OVERVIEW AND HISTORY

Paws for Purple Hearts (PPH) is an innovative therapeutic
service-dog-training program that teaches Veterans and active duty military
personnel with post-traumatic stress disorder (PTSD) the skill of training
service-dogs for Veterans with war-related injuries. The use of psychiatric
service-dogs with patients who have psychiatric disorders is well described
(Barker & Dawson, 1998; Mason & Hagan, 1999). Studies have shown that
under stressful conditions, the presence of a dog is effective at reducing
stress responses in healthy adults, adults with hypertension, and in children
with attachment disorders (Allen, 1991 and 1999; Kortschal, 2010). PPH is
a voluntary program and is used as an adjunct to a wide range of PTSD treatments
including Cognitive Behavioral Therapy (CBT), Prolonged Exposure (PE), Cognitive
Processing Therapy (CPT) and/or medications.

PPH was created by social worker and professional dog trainer Rick Yount, in
2006. It was inspired by the success of a therapeutic service-dog training
program he started in Morgantown, West Virginia to help at-risk teens develop
social skills while providing them with a rewarding career path. Yount’s
Golden Rule Assistance Dog Program
(GRAD) was offered to public school drop-outs through Morgantown’s Alternative
Learning Center. Several GRAD-trained assistance dogs were placed with disabled
veterans. In July 2008, Yount’s Paws for Purple Hearts program was implemented
at the Palo Alto VA’s Men’s Trauma Recovery Program in Menlo Park, California.
One hundred and thirty Service Members have participated in that program. Based
on the program’s success, Yount was asked to establish PPH at Walter Reed’s Army
Warrior Transition Brigade (WTB). Forty-five Soldiers have participated in the
formal Internship Program or the Patient Service-dog Training Program since
February, 2009. In October of 2010, PPH was invited to be part of the PTSD and
Traumatic Brain Injury research and treatment mission at the new National
Intrepid Center of Excellence (NICoE), in Bethesda, MD.

MILITARY NEED FOR SERVICE DOGS AND COST EFFECTIVENESS

A 2009 study published in The American Journal of Public Health found
that close to 40 percent of Iraq and Afghanistan Veterans treated at American
health centers during the previous 6 years were diagnosed with PTSD, depression,
or other mental health issues. The study also found that a lack of social
support—being separated, divorced, widowed, etc., may pose a serious risk for
new post-deployment mental health problems and underscores the need for social
support services for returning Veterans who are unmarried and/or without social
support. (Seal, et al., 2009). Sixty percent of PTSD patients still meet the
criteria for PTSD after being treated with empirically supported interventions
(Monson, 2006; Schnurr, 2007). Therefore, it is imperative to explore adjunctive
treatments for PTSD that may improve outcomes.

There is also substantial interest in service-dogs among Veterans with Spinal
Cord Injury. A survey in 2007 showed that thirty percent of Veterans with Spinal
Cord Injury reported at least some interest in obtaining a service-dog and 42
percent desired information concerning service-dogs (Brashear, 2007).
This urgent need of Veterans for well-trained service-dogs has been recognized
by Congress with passage of several laws authorizing the Department of Veterans
Affairs to provide service-dogs to disabled Veterans.

The 2010 Army Family Action Plan named “provide service-dogs for Wounded
Warriors” as the #2 priority out of 82 issues. Involving Veterans and Service
Members in the training of service-dogs for fellow Veterans creates a symbiotic
opportunity to serve two needs with one program.

The PPH Program supplies high-quality purpose-bred service dogs. Certified
PPH dog-trainers or selected “puppy-parents” take responsibility for the welfare
and behavior of the dogs at all times when the dogs are on military or VA
property. This allows active-duty Service Members and Veterans with PTSD
who cannot or do not own dogs, to have the opportunity to experience the high
quality connection with a dog that provides the powerful relief of PTSD
symptoms. It also circumvents the logistical difficulties of owning and keeping
dogs on base and in medical centers. The program is also highly cost-effective,
providing dog-assisted therapeutic relief to a large number of PTSD patients
with a limited number of service dogs. For instance, in the course of the 30-60
day PPH program offered at the Palo Alto VA Hospital, as many as 20 patients
with PTSD may participate in the training of single service dog. All
participants come away from the program with the valuable knowledge and skills
that will allow them to connect with dogs they may own in the future in the most
rewarding and therapeutic way.

WORKING DOGS/WORKING TRAINERS

Paws for Purple Hearts engages Service Members in the active duty of creating
valuable service dogs for other disabled Service Members. PPH’s training
philosophy is based on a strong bond and positive methods of shaping behaviors.
Mastering the skills and patience required to train a service dog helps the PPH
trainers to regain control of their emotions, focus their attention, and improve
their social competence and overall sense of wellbeing. Two participants in the
Palo Alto VA program have gone on to pursue accreditation as professional dog
trainers and we anticipate that many more will be inspired to become
professionally involved in creating the thousands of service dogs that will be
needed by our wounded warriors.

DOGS HEALING THE WORKPLACE

The impact of the PPH Program on Veterans and Service Members has been
observed to reach well beyond its participants. Nearly 500 Service Members have
benefited indirectly from the presence of the PPH program in PTSD residential
treatment. These are Vets who share rooms with the dogs and their trainers,
those who interact with the dogs as “uncles,” and those who encounter dogs that
are present in their various treatment groups. A conservative estimate of
650 WTs have also been indirectly impacted by the presence of this program on
the campus of Walter Reed. The presence of the program on VA and military
installations brings these PPH participants and their dogs into friendly contact
with dozens of other Service Members every day and provides not only a stress
reducing interaction, but also the opportunity for the PPH participants to share
their positive experiences with fellow Veterans and Service Members.

DOGS HEALING THE HOME

The methodology used in training service dogs to assist individuals with
mobility impairments has striking similarities to the best practices of
effective parenting. The goal of creating a respectful and responsible service
dog requires the employment of sound behavioral shaping techniques based on
positive and humane methods. Using the service dog training to draw
attention to these parallels provides a means to teach critical parenting tools
in a non-threatening manner.

HOW THE PROGRAM WORKS

PTSD symptoms fall into three broad categories: Re-experiencing,
avoidance/numbing and increased arousal. The interventions in the PPH program
are targeted to remediate each category of these symptoms as follows:

Re-experiencing: Procedures used in training PPH service-dogs require
the trainer to focus on the dog’s “here and now” point of view to recognize
the “teachable moments” when instruction will be most effectively processed
and retained. The presence of the dog during a stressful situation or
encounter changes the context of the arousal event and anchors the trainer
in the present, reminding the Service Members or Veterans that they are no
longer in dangerous circumstances. If the patient/trainee does
experience a trigger for symptoms, the presence of the dog can lower anxiety
levels.

Avoidance and Numbing: Training a service-dog requires that it
be carefully exposed to a wide range of experiences in the community. This
creates a need for servicemembers with PTSD to challenge their impulses to
isolate and avoid those same environments that the dogs must learn to
tolerate. Dogs are natural social lubricants and so it is nearly impossible
for the trainer to isolate from other people during this part of the
training. Interactions with others in the company of the dogs, has been
reported to be less threatening since the focus of the interaction is on the
dog and the training.

In order to shape the behavior of a service-dog, the trainer must also
connect successfully with the dog. PTSD patient-trainers must overcome their
emotional and affective numbness in order to heighten their tone of voice,
bodily movements, and capacity for patience in order deliver their commands
with positive, assertive clarity of intention and confidence. In doing this,
trainers soon discover they can earn their dog’s attention and best guide
them to the correct response. The dog’s success must then be rewarded with
emotionally-based praise. The PPH training technique allows the trainers to
experience rewarding positive emotional stimulation and social feedback. The
basic daily needs of a service-dog involve structured activities that also
bring the trainer and dog into the kind of close nurturing contact that
further creates a behavioral and psychological antidote to social avoidance.

Arousal: PPH service-dogs are bred to be responsive to human
emotions and needs. Their sensitivity to and reflection of their trainer’s
emotional state provides immediate and accurate measures of the trainer’s
projected emotion. This also challenges the trainer to overcome his or her
tendency for startle reactions in order to relay a sense of security and
positive feedback when their young dogs are faced with environmental
challenges such a loud sirens and approach by strangers.

PPH service-dogs are also bred to be affectionate and have a low-arousal
temperament that puts their trainers “at ease.” With these dogs at
their sides, PPH trainers perceive greater safety and social competence and
are able to shift out of their hyper-vigilant, defensive mode into a relaxed
state that makes them ready and able to connect with others.

CLINICAL OBSERVATIONS AND PARTICIPANT TESTIMONIALS

Over the last 3 years, anecdotal reports from the PPH program director and
PTSD treatment team members indicate that PPH participants exhibit the following
improvements

Increase in patience, impulse control, emotional regulation

Improved ability to display affect, decrease in emotional numbness

Improved sleep

Decreased depression, increase in positive sense of purpose

Decrease in startle responses

Decrease in pain medications

Increased sense of belongingness/acceptance

Increase in assertiveness skills

Improved parenting skills and family dynamics

Less war stories and more in the moment thinking

Lowered stress levels, increased sense of calm

The following are observations made by Rick Yount after operating PPH for 2
years at the Palo Alto VA and at Walter Reed (Case 1), testimonies from Service
Members who participated in the program (Case 2-5), and testimony from a
disabled Veteran who has received a PPH trained mobility-assistance dog (Case
6). All persons involved in these accounts gave consent for their story to be
included here.

Case 1: A Marine hit by multiple separate IED explosions during his
multiple tours in Operation Iraqi Freedom (OIF) and Operation Enduring Freedom
(OEF), the war in Afghanistan, had been in the PTSD treatment program for
several weeks but was not participating in treatment despite a myriad of
behavioral and pharmacological interventions. He sat in the corner with his
sunglasses on, occasionally twitching his head from side to side in a tic-like
manner. His peers were hesitant to interact with him due to his body language
and lack of motivation to respond to their attempts to connect with him. His
interest in the dogs prompted him to participate in the PPH program. Within two
days of working in the PPH program, he began to smile and bond with the dog. His
involvement led to his first positive interactions with staff and fellow
Veterans. Instead of leaving the PTSD program without successfully completing
it, he was able to finish the entire program and process his trauma through the
support of his dog, peers and treatment team.

Case 2: This testimony was given by a PPH participant with PTSD who
served in Iraq as a National Guard Reservist was struggling with family issues:

My family has noticed a difference in the way I interact with them as a
result of working with my service-dog in training. I am patient with my children
when they are around, I haven’t yelled at them in several months and they aren’t
afraid of me when I’m around. I think that is a direct result of working with my
dog. I have also benefited from the association with my service-dog in training
as we spend time on bonding every day. I feel loved by him and I feel comforted
when he is around. It’s been nearly 4 years since I have felt comforted. When
the dog is with me people that I pass come up and talk to me and I have social
interaction that I wouldn’t have had without the dog. I’m grateful the VA
started this program and I got to be part of it. I wish more veterans got the
opportunity I’ve been given to work with these amazing animals. Please consider
this program on a larger scale so more veterans can benefit from training or
receiving a service-dog.

Case 3: A young soldier, recently returned from Iraq, arrived in the
PTSD program. He had recently attempted to take his own life. His struggle with
hopelessness continued to inhibit his affect and stifle his ability to engage in
treatment. One of the dogs interacted with him while he was waiting for the next
group to begin. He smiled as he pat the dog on his head. He began training the
next day, taking the training tasks very seriously. His psychiatrist told the
Director of the Service-dog Program that the dog had accomplished what the
doctor had been unable to do in 6 months. After his discharge from the program,
the soldier was partnered with a service-dog to continue helping with his PTSD
symptoms.

Case 4: A Marine who had served as a “Devil Dog” (term used to refer
to a Marine) for 19 years was treated for PTSD in 2005. He returned for
treatment in 2006 when he was unable to control his anger. He asked to join the
newly instituted PPH program. He voluntarily provided this account of his
experience with PPH:

I would have never imagined by working with these dogs my life would
change forever. After over a year with severe sleep, depression and anger issues
I found myself able to sleep for longer periods of time during the night and
found myself calm during times where I would have exploded in anger. After
analyzing this major change in my behavior the doctors quickly discovered that
the common denominator was a service-dog trainee named Verde.

Please understand that my story is not a rare one. I have seen remarkable
changes in not only myself but in the other residents that have participated in
the training of these animals. For years doctors have thrown medication at my
issues with minimal results but Verde has caused my life that would have been
surely shortened by my issues to be full again. I know that I will always suffer
with PTSD issues but having my new friend by my side like a fellow Marine will
ensure that my quality of life will improve.

Case 5: Army Veteran returned from Iraq showing many of the signs of
PTSD. Over the next 4 years, his depression deepened, he lost his job and was
divorced. He tried many different medications and finally was enrolled in the
PTSD program. He volunteered this testimony about PPH:

While in the program I learned a lot about PTSD and gained many tools to
help me cope with the disorder, but there was one part of the program that stood
apart; Paws for Purple Hearts. Soon after signing up to train the dogs I found
myself sleeping better and was in a surprisingly good mood, before I knew it I
was not hiding in my room anymore. I started laughing again and I began to
feel good. I felt good about myself and what I was doing; helping to train this
dog for a fellow veteran. Going out and not isolating was a huge leap forward
for me. When you are with one of these dogs everyone wants to stop you and talk
to you. This is not the most comfortable thing for someone with PTSD. After a
while I was having conversation with complete strangers. They come with such a
positive attitude that it reinforces that not all people in the world are bad
and it begins to rebuild trust, which is one of the many things that one with
PTSD struggles with. Another struggle is self restraint and patience and
working with a dog will test your patience. If at any time I feel uneasy or
start to have a little anxiety all I have to do is reach down and pet my dog or
maybe even bend down and give him a hug, and it seems that everything is going
to be just fine.

As my time for being part of this program came near an end, I discovered I
wanted and needed to continue being part of this program. So I enrolled in
The Bergin University of Canine Studies, to further expand my education in the
service-dog field. In May of 2010 I completed the AS program. The PPH program
has not only helped me in learning to cope with PTSD, but it has also helped me
find what it is that I want to do in life. I know without this I could easily
slip back into a lot of the old patterns that I had. My hope is to share with
other Veterans the wonder of working with these dogs and help them get the same
help I got through this program.

Case 6: The following is a personal account of how a PPH bred and
Veteran-trained service dog has affected the life of the Veteran with PTSD who
also uses a wheelchair as a result of his spinal cord injury. He suffered a
spinal cord injury while serving in the Army during the Vietnam era. He received
his service-dog in December 2009. His dog helps by pulling his wheelchair,
retrieving dropped objects, bracing for transfers and opening doors. The impact
that his dog has had on his PTSD symptoms are expressed in his reflections.

Since being paired with my dog I have realized many benefits. Some nights
I couldn’t turn my brain off. I would be on hyper vigilance unable to sleep at
all. I was given Trazadone (PRN). I hated the way I would feel the next day from
Trazadone. Since receiving my dog, my sleep has improved 100 percent and I no
longer use it. Over the years I’ve been prescribed many meds for pain (300 mg.
TDI) Gabapentin for burning pain nerve, Morphine, and Oxycontin. I now take no
pain meds and have learned to live with my constant pain which flairs with
activity or weather. I have also taken several prescription drugs to treat
depression including Prozac and Welbutron. I feel no need to take depression
medication anymore either.

The Veteran also reported significant improvement in his emotional control,
positive social interaction and parenting skills and family dynamics.

THE NEED FOR EMPIRICAL STUDY OF THE PPH INTERVENTION

The PPH research team, in collaboration with senior research officials at the
NICoE, has designed the first research protocol to examine, systematically, PTSD
symptom reduction as well as the physiologic and behavioral changes that occur
during interactions between Veterans suffering from PTSD and dogs in the PPH
service-dog-training program that is ongoing at Walter Reed Army Medical
Center’s Warrior Transition Brigade and at the Palo Alto Veterans Administration
Healthcare System Men’s Trauma Recovery Program.

Based on the scientific literature and clinical observations of the program
to date, we hypothesize that we will be able to scientifically verify that PTSD
symptoms will be reduced, psychosocial functioning will increase and markers of
stress as well as inflammation will be reduced by the human-dog interaction in
the PPH training program. This is exactly the sort of “evidence-based
research” into the mind/body therapeutic effects of human-animal interaction
that has been lacking and causing a resistance to the placement of service-dogs
with Service Members and Veterans despite Congressional approval of legislation
supporting this effort and the growing demand from Wounded Warriors. We
hope that the PPH study will advance not only our scientific understanding of
the healing powers of animals in our lives, but provide the science that the DoD
and VA need to approve animal-assisted therapy programs and the placement of
service dogs with Service Members and Veterans with psychiatric and physical
disabilities.

*** Footnote references are available upon request

Statement of David E. Sharpe,
Founder, Pets2Vets

INTRODUCTION

Madame Chairwoman and Members of the Subcommittee, I would like to thank the
Subcommittee for the opportunity to submit my written testimony. I applaud the
ongoing efforts by Congress to address issues facing active duty servicemen and
women, veterans and emergency first responders such as PTSD, TBI and other
mental health issues.

MY STORY AND THE FOUNDING OF P2V

My name is David E. Sharpe. I am 32 years old and served in the U.S. Air
Force Security Forces for 6 years (1999—2005) where I endured several incidents
that, I thought, didn’t affect my personal relationships with my family,
friends, and colleagues. A short time after my first deployment to Saudi Arabia
during November 2001 in support of Operation Enduring Freedom, I encountered a
one-one confrontation with a Taliban sympathizer pointing his weapon in my face
during Entry Control Point Checks. A second incident occurred in 2004 while I
was on patrol in the country of Pakistan and noticed two suicide bombers
directly outside the base perimeter (razor wire) with a ladder (used to cross
the razor wire) and a belt of explosives strapped to one of the men’s chest
while pointing at the chow hall area. One could only believe that these two men
were planning to fulfill a successful suicide bombing attack against U.S.
military personnel.

Upon my return from my first deployment in March 2002, I began to act
violently towards my family, friends and myself – all symptoms of my being
diagnosed 8 years later by the VA with having PTSD and depression. I found
myself waking up in the middle of the night with cold sweats, random crying,
having outbursts while blaming and questioning myself how I had handled the
life-threatening situations I had found myself in. However, my life would get
much worse before it would improve.

I finally hit bottom on the bedroom floor of my apartment. I sat, legs
folded, ready to finish the fight with the demons that had followed me back from
the war zone: the sudden rages; the punched walls; the profanities tossed at
anyone who tried to help me. There was nothing in my room other than dirty Air
Force uniforms, some empty bottles of alcohol and a crushing despair. I took a
deep breath. I shut my eyes and closed my lips a little tighter around the cool
steel of my .45. And then something licked my ear. I looked around and locked
gazes with a pair of brown eyes. Cheyenne, my sheltered dog, cocked her head to
one side—it was just one of those looks that an animal gives you. It was a look
like: What are you doing? Who’s going to take care of me? Who else is going to
let me sleep in your bed? For a long minute, I stared into the puzzled face of
my 6-month-old pit bull mix. And then slowly, reluctantly, I backed the barrel
of my .45 out of my mouth. There is no doubt about it; I owe Cheyenne my life.

Immediately, I felt so relieved, like a 10,000-pound weight had been lifted
off my chest. Soon after, my family and friends noticed a significant change
in my behavior—a reduced number of outbursts, better attitude, no more suicide
attempts—all because of this little pit bull mix puppy. Cheyenne’s heroics were
in her unconditional love and devotion to me—the devotion and love that most pet
owners can attest to. It’s interesting that a torn-eared puppy from a shabby
animal rescue saved me. Not my father (a retired 32-year U.S. Army RANGER) or my
grandfather (a PT Boat Commander in the South Pacific during World War II) or a
friend. It was Cheyenne who was the force that pulled me back into society. I
couldn’t talk to anybody – not my father, not the counselors – but I can talk to
my sheltered dog, and she never judges me. Eight years later, my father stated,
“He’s [me] a different person now. All that stuff was taking over his life. That
dog [Cheyenne] just listened to him for hours.”[1]
But all that time I had suffered in silence.

For the first time in January 2010 (with the help of a friend), I walked into
the Washington, D.C. VA Hospital to seek additional help in my life. The process
to determine my having PTSD and depression was very frustrating; however, it was
worth the time. I will admit that there was some fear of speaking to a human for
the first time about my military service and I was somewhat apprehensive. But,
Cheyenne helped me become an extrovert, and telling another person or persons
proved to not be so difficult as I thought it would be.

One year later, on January 11, 2011, I married Jenny Fritcher, an Air Force
staff sergeant stationed at Ramstein Air Base in Germany. My wife will be
discharged from active duty and join me in Arlington, Virginia in August 2011.
More importantly, we’re expecting our first child in January 2012—I credit all
of this to my sheltered dog, Cheyenne. Through the unconditional love of my
sheltered dog and my training her to perform basic manners (e.g. sit, stay,
nudge my hand when I get hyper vigilant) I became resilient and am now a
productive member of society, working as a Program Analyst in the Intelligence
Community.

Because of Cheyenne and my belief that other veterans could benefit from
animals like her, I set out on a mission in October 2009 with only $2,500 in my
savings account to create the nonprofit organization, Pets 2 Vets, or P2V
(www.P2V.org). P2V pairs active duty military, veterans and emergency
first responders dealing with the stress of their service with shelter animals
as part of their healing process.
This innovative and enterprising organization proves that an outside-of-the-box
concept can help others like me in a very short time and is somewhat grounded in
science. A July 2011 study published in the Journal of Personality and Social
Psychology revealed that pet owners had greater self-esteem, greater levels
of exercise and physical fitness, and they tended to be less lonely than
nonowners.[2]
These are exactly the qualities needed by veterans with mental health disorders,
and my goal is for P2V to aid them in their recovery while at the same
time saving our nation’s shelter animals.

Today,
P2V has aided dozens of our nation’s heroes while finding loving homes
for shelter animals in just under its first 2 years of operation. The
organization currently serves veterans by using volunteers who are trained by a
VA licensed clinical psychologist. The volunteers pick up the veterans from
their homes (rural areas included) and transport them to P2V-partner shelters to
adopt or visit animals of their choice – the VA doesn’t have to provide the
facility, and veterans are removed from the monotony of a hospital environment.
P2V also provides transportation for veterans by its volunteers in rural areas
to visit or adopt shelter animals. P2V pays for or its partner shelters waive
adoption fees, supplies a gift card for necessary pet equipment (leash, collar,
feeding-water bowls and crate), and pays for the veteran’s first 2 years of pet
insurance (Banfield Pet Hospital Wellness Plans; located at 770 locations
nationwide), and basic manners training. Finally, veterans are provided multiple
options in the selection of a companion animal (dog or cat). In conjunction with
the appropriate health care services, the entire P2V process allows veterans to
feel a sense of self worth and accomplishment that helps lead them on the road
to becoming a productive member of society. For example, Marine sergeant Jimmy
Childers, recipient of a shelter dog named Tidus stated, “Tidus isn’t going to
be fetching my [prosthetic] leg for me or anything. He’s here to bring joy into
my life, and he does that every day.”[3]

PROPOSED LEGISLATION

H.R.198, Veterans Dog Therapy Training Act, introduced by Reps. Grimm (R-NY),
Michaud (D-ME), King (R-NY) and Lance (R-NJ) provides the assessment of
addressing post-deployment mental health and PTSD symptoms through a therapeutic
medium of training service dogs for veterans with disabilities. P2V supports the
concept of such legislation but is concerned that the bill is too narrowly
drafted to benefit a large number of veterans.

Currently, the legislation only allows for a pilot program to assess the
effectiveness of the training of service animals on the mental health of
veterans suffering from post-traumatic stress disorder or other post deployment
mental health conditions. However, as we have learned over the years, the VA
needs all available resources—a toolbox of sorts—to address the mental health
crisis facing our nation’s veterans. Therefore, P2V recommends the Committee
broaden the scope of the bill to encourage the VA to partner other
community-based service/companion animal programs already in existence and
review their effectiveness on the well-being of veterans in need. P2V as well as
many other organizations can provide successful and inexpensive models that can
augment traditional services as well as serve as alternatives to conventional
care.

In conclusion, while many veterans do require the assistance of a highly
trained service animal and could benefit from training such animals, most
veterans with whom I have spoken simply are looking for the companionship of an
animal to feel acknowledged and accepted.

My sheltered dog is the sole reason why I am here today. Furthermore, my dog
has allowed me to grow close relationships with my family and friends with the
help of the Department of Veterans’ Affairs, and I believe that other veterans
can benefit from the same type of companionship. I appreciate your time and the
opportunity to share my personal experiences with having PTSD, educating you
about P2V and making recommendations on H.R. 198.

Service Women’s Action Network (SWAN) is a national organization that
supports, defends, and empowers today’s servicewomen and women veterans of all
eras. SWAN’s vision is to transform military culture by securing equal
opportunity and the freedom to serve in uniform without threat of harassment,
discrimination, intimidation or assault. SWAN also seeks to reform veterans’
services on a national scale to guarantee equal access to quality health care,
benefits and resources for women veterans and their families.

SWAN fully supports H.R. 2074, a bill to require a comprehensive policy on
reporting and tracking sexual assault incidents and other safety incidents that
occur at Department of Veterans Affairs (VA) medical facilities.

SWAN has unique insight into the issue of sexual assault at the VA. Our
National Peer Support Helpline receives numerous calls from veterans seeking
help to remedy a negative experience at the VA. Some of these veterans, both men
and women, tell us they were sexually harassed or sexually assaulted at VA
facilities, reported it, and saw absolutely nothing done by the VA in response.

One client told us that while receiving an EKG, a male technician
inappropriately touched her breasts during the procedure and repeatedly
commented on her appearance. Afterward she did not know how to report the
incident, left the hospital and has not returned to the VA since.

Another veteran was raped by her VA psychiatrist who was a retired Air
Force officer. She reported this to the VA administration who told her they
could do nothing based on her word alone. She then reported him to the
authorities. Although he was not prosecuted, as a result of this veteran’s
courage the psychiatrist had his treatment license suspended for 5 years.

Another caller who is employed by the VA as a police officer has
apprehended a VA technician twice for sexually assaulting patients and
turned him over to the VA administration both times. Yet this technician has
not been charged with any crime, is still employed at the same VA and still
regularly works with women patients. The officer is completely frustrated
with a system that allows rapists to roam the hospitals free to prey on
vulnerable patients.

H.R. 2074 would help to reform this system by requiring the VA develop a
comprehensive program for reporting and handling sexual assault complaints, a
first step in what SWAN hopes will become a rigorous system that keeps everyone
who uses the VA safe and secure. An institution that provides for the health
care needs of veterans ought to have an effective reporting system in place,
particularly given the rampant levels of sexual assault and sexual harassment
within the active duty military. The Department of Defense estimates that in
2010 alone, there were over 19,000 sexual assaults in the military[1],
or 52 sexual assaults per day. It is negligent and dangerous to think that
somehow those tens of thousands of survivors and perpetrators simply go away
after being discharged. The numbers of sexual trauma survivors, both male and
female, utilizing the VA is substantial. VA reports that in FY 2010 68,379
patients had at least one outpatient visit to a VHA facility that was for the
treatment of a condition(s) related to Military Sexual Trauma. 61 percent (or
41,475) of those patients were women; 39 percent (or 26,904) were men.[2]

VA serves tens of thousands of high-risk veterans every year, and as an
institution it must accept responsibility for the care and safety of all its
patients from the time they walk onto the grounds of a VA facility until they
walk off. The VA must not only do so by providing top notch medical treatment,
but also superior administrative support as well. That means every VA run
facility must develop a well publicized process in place to handle sexual
harassment and sexual assault complaints, must have policies that enforce rules
and discipline offenders, must train every member of their staff annually on
sexual harassment and sexual assault response, must maintain a security presence
that is attentive and effective, and must invest in an infrastructure that
allows for a completely safe visit. Safety and care for VA patients should not
start or stop at the front door.

The stakes are high. With the number of veterans eligible for care rising
year after year and with the rape, sexual assault and sexual harassment crisis
continuing unabated in the military, it is essential that the VA protect
patients from sexual predators. If the VA fails to do this, veterans desperately
in need of care will avoid seeking it out which will result in untold suffering,
chronic mental illness, substance abuse, homelessness and in some cases suicide
or death. Our nation’s veterans deserve better, and H.R. 2074 will help to
ensure that.

I am honored to submit this statement in support of Section 8 of the Veterans
Health Care Facilities Capital Improvements Act of 2011. This section will now
replace and mirrors legislation that I introduced in the form of H.R. 1658.
Section 8 of this legislation seeks to rename the Department of Veterans Affairs
telehealth clinic in Craig, Colorado, after Major William Edward Adams.

It is only fitting and proper that we pay tribute to a heroic American who
was awarded our nation's highest honor for his conspicuous gallantry in the
Kontum Province in the Central Highlands of Vietnam. Major William Edward Adams
is an inspiration to every citizen of our great nation, and a reminder to all
Americans that some will sacrifice everything to preserve our way of life.

Maj. Adams was born in Casper, Wyoming, and raised in Craig, Colorado. He
went to high school in Missouri at the Wentworth Military Academy. He graduated
from Colorado State University, where he also met his future wife Sandra Adams.
Upon graduation he joined the United States Army. Major Adams was deployed to
Vietnam in 1970.

On May 25th, 1971, Maj. Adams willingly volunteered for a helicopter rescue
mission that would undoubtedly endanger his lightly armored aircraft and his
life. The mission was to fly into a remote fire base that was under heavy attack
to pick up three critically wounded soldiers. Maj. Adams was fully aware of the
advantageous position of the enemy's formidable anti-aircraft guns; as well as
the clear skies that would provide no cover from the imminent barrage. While
directing and coordinating fire support from other attack helicopters, Major
Adams landed his aircraft and picked up the three wounded soldiers. As he began
his return flight, Maj. Adams' helicopter was bombarded with enemy rocket and
gunfire. He calmly regained control of the aircraft, and prepared to make an
emergency landing, but the helicopter exploded before Maj. Adams could touch
down. For these actions, Major William Edward Adams posthumously received the
Medal of Honor.

It gives me great pride to know that I have fellow countrymen who are capable
of such selfless feats of bravery. Thus, renaming the VA telehealth clinic in
Craig, Colorado, after Major Adams honor is an appropriate honor and is also
supported by the community.

Sincerely,

Scott TiptonMember of Congress

Statement of Heather L. Ansley,
Esq., MSW, Director of Veterans Policy, VetsFirst, a Program of United Spinal
Association

Chairwoman Buerkle, Ranking Member Michaud, and other distinguished Members
of the Subcommittee, thank you for the opportunity to submit written testimony
regarding VetsFirst’s views on the Veterans Dog Training Therapy Act (H.R. 198)
and the Veterans Equal Treatment for Service Dogs Act (H.R. 1154).

VetsFirst represents the culmination of 60 years of service to veterans and
their families. United Spinal Association, through its veterans service program,
VetsFirst, maintains a nationwide network of veterans service officers who
provide representation for veterans, their dependents and survivors in their
pursuit of Department of Veterans Affairs (VA) benefits and health care before
the VA and in the Federal courts. Today, United Spinal Association is not only a
VA-recognized national veterans service organization, but is also a leader in
advocacy for all people with disabilities.

Service animals provide multi-faceted assistance to people with disabilities.
Specifically, service animals promote community integration. In addition to
performing specific tasks such as pulling a wheel chair or opening a door, these
same service animals can also help to break down barriers between people with
disabilities and society. In addition to increased social interaction, many
people with disabilities also report experiencing a greater sense of
independence.

For many years, Congress has recognized the benefits that service animals
provide for veterans with disabilities. Specifically, Congress has authorized VA
to provide guide dogs for veterans with visual impairments. In 2002, Congress
expanded the authority to include service dogs for veterans with hearing and
mobility impairments. Most recently, Congress further expanded VA’s authority to
include service dogs for veterans who have mental health concerns.

VetsFirst is pleased to lend our support to legislation that we believe will
further promote and facilitate the use of service animals by veterans with
disabilities.

The Veterans Dog Training Therapy Act (H.R. 198)

VetsFirst strongly supports the Veterans Dog Training Therapy Act (H.R. 198)
and the substitute amendment that will be submitted at Committee markup. The
proposed amendment to this legislation would ensure that accredited service dog
agencies and trainers will provide appropriate training and consultation with VA
to provide opportunities for veterans with mental health concerns to train
service dogs for fellow veterans with disabilities.

We support efforts to ensure that properly trained service animals are
available to veterans who can benefit from their assistance. The Veterans Dog
Training Therapy Act provides a unique opportunity to benefit not only veterans
seeking the assistance of a service dog but also provides veterans with
post-deployment mental health concerns or post-traumatic stress disorder the
opportunity to benefit from training these dogs. The dual nature of this
approach will assist a wide range of veterans.

VetsFirst also believes that requiring VA to work in conjunction with
accredited service dog agencies and trainers will benefit all participating
veterans. Specifically, veterans assisting with training will be required to
follow a structured process to ensure that the service dog is appropriately
trained. As a result, veterans receiving these service dogs will be assured that
the dogs are properly trained and able to assist them. Furthermore, the skills
learned by the veteran trainers could be helpful in allowing them to
successfully pursue a career in the service animal field.

Consequently, VetsFirst urges passage of the Veterans Dog Training Therapy
Act. We understand that Congressman Grimm has identified possible offset funding
for this important legislation.

The Veterans Equal Treatment for Service Dogs Act (H.R. 1154)

VetsFirst, strongly supports the Veterans Equal Treatment for Service (VETS)
Dogs Act (H.R. 1154). This legislation would ensure that all veterans with
disabilities who use service dogs are able to access VA facilities.

VA regulation, 38 C.F.R. § 1.218(a)(11), which applies to “all property under
the charge and control of VA,” states that, “Dogs and other animals, except
seeing-eye dogs, shall not be brought upon property except as authorized by the
head of the facility or designee.” Exempting guide dogs but not service dogs
from VA property leads to unequal protection for veterans and people with
disabilities. In addition, allowing the use of service dogs to vary by VA
facility has resulted in veterans encountering different access policies based
on the discretion of the individual facility directors.

The VETS Dogs Act, which has wide bipartisan support, specifically states
that the VA Secretary may not prohibit the use of service dogs in VA facilities
or on VA property. .

Immediately prior to the introduction of this legislation, the Veterans
Health Administration (VHA) issued VHA Directive 2011-013 titled, “Guide Dogs
and Service Dogs on VHA Property.” If properly implemented and maintained, the
directive could address past access difficulties. Although VetsFirst
acknowledges the actions of VA in issuing the directive, we believe that the
VETS Dogs Act must be passed to ensure that veterans with disabilities who use
service dogs have the assurance of equal access to VA facilities.

Thus, we urge swift passage of the VETS Dogs Act to specifically mandate
access to VA services and facilities for all veterans with disabilities who use
service dogs.

Thank you for the opportunity to submit written testimony concerning
VetsFirst’s views on H.R. 198 and H.R. 1154. VetsFirst believes that the ability
to use service animals is a critical option for many people with disabilities.
Together, H.R. 198 and H.R. 1154 provide the legislative authority to ensure
that veterans are able to more fully benefit from service dogs.

We appreciate your leadership on behalf of our nation’s veterans with
disabilities. VetsFirst stands ready to work in partnership to ensure that all
veterans are able to reintegrate in to their communities and remain valued,
contributing members of society.

Statement of Wounded Warrior Project

Chairwoman Buerkle, Ranking Member Michaud and Members of the Subcommittee:

Wounded Warrior Project (WWP) welcomes the Subcommittee’s consideration of
H.R. 1855 and is pleased to offer our views on this important bipartisan
legislation.

WWP works to help ensure that this generation of wounded warriors thrives –
physically, psychologically and economically. Our policy objectives are targeted
to filling gaps in programs or policies -- and eliminating barriers -- that
impede warriors from thriving. Importantly, those objectives reflect the
experiences and concerns of wounded warriors and family members whom we serve
daily across the country.

H.R. 1855 addresses some of the deepest concerns we have heard from warriors’
families, and we are very pleased to be able to enthusiastically support this
measure. Its enactment would realize a key goal of our policy agenda. Most
important, it would materially change lives.

Traumatic Brain Injury Rehabilitation

Impressive military logistics and advances in military medicine have saved
the lives of many combatants injured in Iraq and Afghanistan who would likely
not have survived in previous conflicts. As a result, servicemembers are
returning home in unprecedented numbers with severe polytraumatic injuries.
Among the most complex are severe traumatic brain injuries. Each
case of traumatic brain injury is unique. Depending on the injury site and other
factors, individuals may experience a wide range of problems – from profound
neurological and cognitive deficits manifested in difficulty with speaking,
vision, eating, or incontinence to marked behavioral symptoms. While individuals
who have experienced a mild or moderate TBI may experience symptoms that are
only temporary and eventually dissipate, others may experience symptoms such as
headaches and difficulty concentrating for years to come.

Those with severe TBI may face such profound cognitive and neurological
impairment that they require a lifetime of caretaking. As clinicians
themselves recognize, it is difficult to predict a person’s ultimate level of
recovery.[1] But to be effective in
helping an individual recover from a brain injury and return to a life as
independent and productive as possible, rehabilitation must be targeted to the
specific needs of the individual patient. In VA parlance, rehabilitation must be
“veteran-centered.”

While many VA facilities have dedicated rehabilitation-medicine staff, the
scope of services actually provided to veterans with a severe TBI can
be limited, both in duration and in the range of services VA will provide or
authorize. It is all too common for families -- reliant on VA to help a loved
one recover after sustaining a severe traumatic brain injury -- to be told that
VA can no longer provide a particular service because the veteran is no longer
making significant progress. Yet ongoing rehabilitation is often needed to
maintain function,[2]
and veterans with traumatic brain injury who are denied maintenance therapy can
easily regress and lose cognitive, physical and other gains made during earlier
rehabilitation.

Some do make a good recovery after suffering a severe TBI. But many have
considerable difficulty with community integration even after undergoing
rehabilitative care, and may need further services and supports.[3] Medical literature has documented
the need to use rehabilitative therapy long after acute care ends to maintain
function and quality of life.[4],[5],[6]
While improvement may plateau at a certain point in the recovery process, it is
essential that progress is maintained through continued therapy and support. The
literature is clear in demonstrating the fluctuation that severe TBI patients
may experience over the course of a lifetime. One study found that even 10 to 20
years after injury individuals were still suffering from feelings of hostility,
depression, anxiety, and further deficiencies in psychomotor reaction and
processing speed.[7] While some are able to maintain
functional improvements gained during acute rehabilitative therapy, others
continue to experience losses in independence, employability, and cognitive
function with increasing intervals of time.[8] Given such variation in individual progress,
rehabilitation plans must be dynamic, innovative, and long term – involving
patient-centered planning and provision of a range of individualized services.[9]

For this generation of young veterans, reintegration into their communities
and pursuing life goals such as meaningful employment, marriage, and independent
living may be as important as their medical recovery. Yet studies have found
that as many as 45 percent of individuals with a severe traumatic brain injury
are poorly reintegrated into their community, and social isolation is reported
as one of the most persistent issues experienced by such patients.[10]
Yet research has demonstrated that individuals with severe TBI who have
individualized plans and services to foster independent living skills and social
interaction are able to participate meaningfully in community settings.[11]
While improving and maintaining physical and cognitive function is paramount to
social functioning, many aspects of community reintegration cannot be achieved
solely through medical services. Other non-medical models of
rehabilitative care -- including life-skills coaching, supported employment, and
community-reintegration therapy -- have provided critical support for community
integration. But while such supports can afford TBI patients opportunities for
gaining greater independence and improved quality of life, VA medical facilities
too often deny requests to provide these “non-medical” supports for TBI
patients. While such services could often be provided under existing law
through other VA programs[12], it is troubling that institutional barriers
stand in the way of meeting veterans’ needs under a “one-VA” approach.
Instead, rigid adherence to a medical model and foreclosing social supports is,
unfortunately, a formula for denying veterans with severe traumatic brain injury
the promise of full recovery. This barrier must be eliminated.

H.R. 1855

H.R. 1855 would amend current law to clarify the scope of VA’s
responsibilities in providing rehabilitative care to veterans with traumatic
brain injury. While current law (codified in sections 1710C and 1710D of title
38, U.S. Code) directs VA to provide comprehensive care in accord with
individualized rehabilitation plans to veterans with traumatic brain injury, in
some instances warriors with severe traumatic brain injury are not receiving
services they need, and in other instances, VA has cut off rehabilitative
services prematurely.

Ambiguities in current law appear to contribute to such problems. For
example, while the above-cited provisions of law do not define the term
“rehabilitation,” the phrase “rehabilitative services” is defined for VA
health-care purposes (in section 1701(8) of title 38) to mean “such
professional, counseling, and guidance services and treatment programs as are
necessary to restore, to the maximum extent possible, the physical, mental, and
psychological functioning of an ill or disabled person.” That provision could be
read to limit services to restoring function, but not to maintaining
gains that have been made. (Yet limiting TBI rehabilitative care in that manner
risks setting back progress that has been made.) As defined, the term
“rehabilitative services” is also limited to services to restore “physical,
mental and psychological functioning.” In our view, rehabilitation from a
traumatic brain injury should be broader, to include also cognitive and
vocational functioning, and, given the research cited above, should not
necessarily be limited to services furnished by health professionals.

In essence, H.R. 1855 would provide that in planning for and providing
rehabilitative services to veterans with traumatic brain injuries, VA must
ensure that those services --

are directed not simply to “improving functioning” but to sustaining
improvement and preventing loss of functional gains that have been achieved
(and, as such, that rehabilitation may be continued indefinitely); and

are not to be limited to services provided by health professionals but
include any other services or supports that contribute to maximizing the
veteran’s independence and quality of life.

WWP strongly supports this legislation. It would eliminate barriers too many
have experienced, and would offer the promise of making good on the profound
obligation we owe those who struggle with complex life-changing brain injuries.

We urge the Committee to adopt this important legislation, and would welcome
the opportunity to work with you to ensure its enactment.

[12] See VA’s program of independent living services
(administered by the Veterans Benefits Administration) under 38 U.S.C. sec.
3120, and VA’s authority under 38 U.S.C. sec. 1718(d)(2) to furnish supported
employment services as part of the rehabilitative services provided under the
compensated work therapy program (administered by the Veterans Health
Administration).

In accordance with the Office of
Management and Budget Circular A-50, the Department of Veterans Affairs (VA) is
providing an update on the actions taken by VA in response to the eight
recommendations contained in the June 7, 2011, U.S. Government Accountability
Office (GAO) final report, VA Health Care: Action Needed to Prevent
Sexual Assaults and other Safety Incidents (GAO-11-530).

In commenting on GAO’s draft report, VA concurred with GAO’s recommendations
to the Department. The enclosure provides details about progress VA has
made in implementing GAO’s recommendations since responding to the draft report.

To improve VA’s monitoring of allegations of sexual assault, we
recommend that the Secretary of the Department of Veterans Affairs direct the
Under Secretary for Health to take the following four actions:

Recommendation 1: Ensure that a consistent
definition of sexual assault is used for reporting purposes by all medical
facilities throughout the system to ensure that consistent information on these
incidents is reported from medical facilities through VISNs to VHA Central
Office Leadership.

VA Update to Final Report: Concur.
An interdisciplinary work group was formed and charged with developing a
definition of sexual assault. The work group adopted the following definition
of sexual assault:

“Any
type of sexual contact or attempted sexual contact that occurs without the
explicit consent of the recipient of the unwanted sexual activity. Assaults
may involve psychological coercion, physical force, or victims who cannot
consent due to mental illness or other factors. Falling under this definition
of sexual assault are sexual activities such as forced sexual intercourse,
sodomy, oral penetration, or penetration using an object, molestation,
fondling, and attempted rape. Victims of sexual assault can be male or
female. This does not include cases involving only indecent exposure,
exhibitionism, or sexual harassment.”

VA’s Assistant Secretary for the Office of Operations, Security
and Preparedness (OSP) communicated this definition, as well as other policy
and processes, to Under Secretaries, Assistant Secretaries, and other key
officials in a June 16, 2011, memorandum, “Clarification of Policy of Sexual
Assault Reporting” (Attachment A). The Deputy Under Secretary for Health for
Operations and Management (DUSHOM) subsequently issued a July 7, 2011, memorandum,
“Actions Needed to Improve Reporting of Allegations of Sexual Assaults”
(Attachment B), to VISN Directors regarding the definition, as well as the new
policies and processes. This memorandum required VHA field facilities to take
specific actions in regard to reporting sexual assaults including:

Specifying a
definition for what is to be reported as an allegation of or an actual
sexual assault;

Outlining
requirements for reporting all allegations of sexual assault on VA
property (or off-property in the execution of official VA duties) in
accordance with VA Directive 0321, Serious Incident Reports;

Requiring
facilities to submit:

an initial
issue brief that includes specific information to the Office of the
DUSHOM within 24 hours of reporting the incident, and a follow-up issue
brief to provide details about any investigation, results of the
investigation, actions taken by the facility, and any process or policy
improvements made to mitigate future events;

Communicating
with the Office of Inspector General (OIG).

Recommendation 2: Clarify expectations about what
information related to sexual incidents should be reported to and communicated
within VISN and VHA Central Office leadership teams, such as officials
responsible for residential programs and inpatient mental health units.

VA Update to Final Report: Concur.
The two memoranda mentioned in the status update for Recommendation 1 clarified
and reinforced expectations on what information related to sexual incidents
should be reported. The interdisciplinary work group is continuing its review
and will identify any additional guidance and clarification that is needed in
its report to the Under Secretary for Health (USH) no later than (NLT)
September 30, 2011.

Recommendation 3:
Implement a centralized tracking mechanism that would allow sexual assault
incidents to be consistently monitored by VHACO staff;

VA Update to Final Report: Concur.
The interdisciplinary work group is developing and will implement a
computerized mechanism to monitor sexual assault and other safety incidents.
Currently, the Office of the DUSHOM is conducting centralized tracking and
monitoring through a manual process.

An automated process is under fast track development. Nine VISNs
are piloting key components, including the automation of issue briefs. It is
expected that the new automated centralized tracking system will replace the
manual centralized tracking system by October 31, 2011. An updated timeline
and status will be provided in a report to the USH NLT September 30, 2011.

Recommendation 4:
Develop an automated mechanism within the centralized VA police reporting
system that signals VA police officers to refer cases involving potential
felonies, such as rape allegations, to the VA OIG to facilitate increased communication
and partnership between these two entities.

VA Update to Final Report: Concur.
As of June 20, 2011, when VA police officers enter information into the
Veterans Affairs Police System (VAPS), the VAPS automatically sends the VA OIG
all incidents of sexual assaults and other major felonies. The VAPS system
automatically sends a special alert to VA OIG Special Agents at VA OIG
Headquarters and to all regional Special Agents in Charge of VA OIG Field
Offices.

To help identify risks and address vulnerabilities in physical
security precautions at VA medical facilities, we recommend that the Secretary
of the Department of Veterans Affairs direct the Under Secretary for Health to
take the following four actions.

Recommendation 5:
Establish guidance specifying what should be included in legal history
discussions with veterans and how this information should be documented in
veterans’ psychosocial assessments;

VA Update to Final Report: Concur.
The
interdisciplinary work group is conducting a
literature review and consulting with peers to explore what information should
be obtained when assessing a Veteran’s risk for misconduct, and how this
information might be used within the required limits for maintaining
confidentiality and rights of privacy.

The
work group’s assessment, in consultation with the VA Office of General Counsel,
and the VHA Office of Ethics in Health Care, will determine what specific
guidance may need to be developed. An action plan for the development,
implementation, and communication of the guidance will be established once the
assessment is complete. This process will also address what appropriate action
needs to be taken to standardize documentation in Veterans’ psychosocial
assessments.

An updated timeline and status will be provided in a report to the
USH NLT September 30, 2011, in regard to establishing guidance specifying
what should be included in legal history discussions with Veterans and how this
information should be documented in Veterans’ psychosocial assessments.

VA Update to Final Report: Concur.
The Office of the DUSHOM has worked with the interdisciplinary work group to
re-emphasize the need for routine testing of panic alarms as well as to ensure
the alarms are functioning correctly.

The DUSHOM issued a memorandum,
“Actions Needed to Improve Physical Security Requirements” on June 10, 2011,
(Attachment C), that tasked each Network Director to ensure that each facility
within each network has a physical security assessment plan that includes:

Policies for use and testing of
alarm systems, including panic alarms:

Regular
testing of these alarm systems, including panic alarms;

Documentation
of testing; and

A plan
and implementation strategy for 24/7 response capabilities and preventative
maintenance.

All VISN Directors have documented and attested, with supporting documentation,
that each VAMC has been reviewed for compliance, each VISN is compliant with
physical security policies, and action plans and timelines have been developed
to implement physical assessment plans to ensure adequate security controls.

The interdisciplinary work group will provide an update on the
outcome of this action item in its September 30, 2011, report to the USH.

VA Update to Final Report: Concur.
In order to ensure that each facility is addressing the issue, the DUSHOM, in
the previously referenced June 10, 2011, memorandum, re-emphasized existing
policy and procedures about the use of alarm systems and tasked VISN Directors
to ensure that local facilities have established systems that meet the specific
location and function needs as well as develop a process to include regular
testing of these systems based on industry and manufacturers’ standards.

As noted in Recommendation 6, each VISN Director has documented
and attested that each VAMC is in compliance with the new requirements.

The interdisciplinary work group will provide an update on the
outcome of this action item in its September 30, 2011, report to the USH.

Recommendation 8:
Require relevant medical center stakeholders to coordinate and consult on (1)
plans for new and renovated units and (2) any changes to physical security
features, such as closed-circuit television cameras.

VA Update to Final Report: Concur.
At the national level, the interdisciplinary work group is working with VA
Office of Construction and Facilities Management (CFM) and OSP about how best
to formalize consultation during the planning and design processes for all construction projects. CFM currently maintains
a Technical Information Library including planning and design standards for all
VA services/departments, and these standards currently provide planning and
design guidelines for VA construction projects. Incorporating planning design
standards emphasizing privacy and safety concerns will need to be considered
during the development of new standards and updates to current standards. The
interdisciplinary work group will include a recommendation about this issue in
its September 30, 2011, report to the USH.

VA Directive
0321, Section 2.a., January 21,2010, (attached) requires all Serious Incidents
in the VA to be reported to the VA Integrated Operations Center (VA IOC) as
soon as possible but no later than 2 hours after the awareness of the incident.

Section 2.c.(9).
of VA Directive 0321 includes a requirement to report sexual assaults:
"Incidents on VA property that result in serious illness or bodily injury
to include sexual assault, aggravated assault and child abuse."

To ensure
accurate reporting, sexual assault is defined as "any type of sexual
contact or attempted sexual contact that occurs without the explicit consent of
the recipient of the unwanted sexual activity. Assaults may involve
psychological coercion, physical force, or victims who cannot consent due to
mental illness or other factors. Falling under this definition of sexual
assault are sexual activities such as forced sexual intercourse, sodomy, oral
penetration, or penetration using an object, molestation, fondling, and
attempted rape. Victims of sexual assault can be male or female. This does not
include cases involving only indecent exposure, exhibitionism, or sexual
harassment."

It is important
that leadership know in a timely manner all allegations of sexual assault that
occur on VA property or at any time while official VA duties are being
performed. As such, effective immediately, all Under Secretaries, Assistant
Secretaries, and other Key Officials will ensure that the IOC is notified
within two hours of any and all allegations of sexual assault. Notification may
be made via telephone by calling (202) 461-5510 or via email to vaioc@va.gov.
It is understood that these initial notifications will be followed by more
comprehensive information as it becomes available.

1. PURPOSE. To establish policy for Serious Incident Reports (SIR) In order to
facilitate reporting of certain high-interest incidents, significant events,
and critical emerging or sensitive matters occurring throughout VA that are
likely to result in National media or Congressional attention.

2.
POLICY.

This directive requires that Serious Incidents in the VA
infrastructure that are likely to result in National media or Congressional
attention be reported to the VA Integrated Operations Center (VA IOC) as soon
as possible but no later than 2 hours after awareness of the incident.

The SIR will inform the Secretary of any adverse event or
incident likely to result In National media or Congressional attention.
Discussed within the VA
Handbook 0321 Serious
Incident Reports, are the identified procedures and operational requirements
implementing this policy.

The
following are the reportable events and incidents:

Public information regarding the arrest of a VA Employee
(police report, public release, etc.);

In the event
of an actual or alleged data breach, notify the information security officer,
privacy officer, and supervisor, and follow other established procedures as
provided by VA Handbooks 6500 "Information Security Program," and 6500.2 "Management
of Security and Privacy Incidents."

3. RESPONSIBILITIES.

The Secretary of Veterans Affairs will ensure the
development of policies and procedures for Serious Incident Reports.

Assistant
Secretary for Operations, Security, and Preparedness

Ensures development of coordinated procedures,
standardized reports, forms and tools for Implementing polley In this Directive
In consultation with Under Secretaries, Assistant Secretaries, and Other Key
Officials;

Implements and maintains policies and procedures for SIRs;

Informs Administrations, Staff and Program Offices, of
SIR submissions;

Background. On June 7, 2011, the Government Accountability Office (GAO) issued its report: VA HEALTH CARE:
Actions Needed to Prevent Sexual Assaults and Other Safety Incidents, and
provided recommendations to the Department of Veterans Affairs to improve both
the reporting and monitoring of sexual assault incidents and the tools used to
identify risks and address vulnerabilities at VA facilities.

The safety and security of all
individuals on our campuses is paramount. A multidisciplinary team, the Safety
and Security from Sexual Victimization Workgroup, has been established to
address all of the recommendations in this report and will provide an action
plan by July 15, 2011. To ensure we continue to provide a safe environment at
our facilities, there are several actions we can undertake prior to the
workgroup issuing its final recommendations -namely ensuring compliance with
reporting allegations of sexual assaults.

To ensure
accurate reporting, sexual assault is as defined by GAO and adopted by the VA's
Safety and Assault Prevention Workgroup:

"Any type of sexual contact or attempted sexual
contact that occurs without the explicit consent of the recipient of the
unwanted sexual activity. Assaults may involve psychological coercion, physical
force, or victims who cannot consent due to mental illness or other factors.
Falling under this definition of sexual assault are sexual activities such as
[but not limited to] forced sexual intercourse, sodomy, oral penetration, or
penetration using an object, molestation, fondling, and attempted rape. Victims
of sexual assault can be male or female. This does not include cases involving
only indecent exposure, exhibitionism, or sexual harassment."

You, and your subordinate
managers, must ensure that all allegations of sexual assault on VA property (or
off-property in the execution of official VA duties) involving a Veteran, VA
employee, contractor, visitor, or volunteer are reported within 2 hours in
accordance with the Serious Incident Reporting guidelines. If the incident
occurs during an off-tour, the Administrative Officer of the Day will report
the incident to the following email group VAIOC@va.gov as a "Heads
Up" (an alleged incident
of sexual assault has occurred, more complete information to follow). Within 24
hours of reporting the incident, an Issue Brief (IB) will be sent to the Deputy
Under Secretary for Health for Operations and Management through your Veterans
Integrated Service Network Support Team.

The following elements should be
included in the IB: date of incident; location of the incident; description of
the incident; immediate actions taken; type of investigation the facility plans
to conduct; any involvement or reporting to an outside law enforcement agency
or health care organization.

Each VISN must submit a follow up
issue brief to: provide details regarding additional actions taken by the
facility to investigate the allegations; any actions taken by the facility, to
include personnel actions; as a result of its investigation; legal disposition
and whether the incident is substantiated; and any process improvements or
policy changes being made to try to mitigate future events.

Information to be reported to the
Office of the Inspector General 38 C. F. R. 1.203 (2010) [1.203 covers
reporting to VA. Police] requires the following: Information about actual or
possible violations of criminal laws related to VA programs, operations,
facilities, or involving VA employees, where the violation of criminal law
occurs on VA premises, will be reported by VA management officials to the VA
police component with responsibility for the VA station or facility in
question. If there is no VA police component with jurisdiction over the
offense, the information will be reported to Federal, state or local law
enforcement officials, as appropriate.

All criminal matters that involve
felonies shall be reported to the Office of Inspector General (OIG) as required
by regulation 38 C. F. R. 1.204
(2010). The regulation requires all potential felonies including rape,
aggravated assault and serious abuse of the patient to be reported to VA OIG
for investigation. Hence all allegations of sexual assault will be reported to
the OIG to enable them to determine which allegations rise to the level of a
potential felony.

It is important
for all sexual assaults to be reported up and through the VHA management chain
starting with facility leadership to the VISN and to VACO in a timely manner.
Parallel reporting to the OIG will occur where required.

Additional guidance regarding the reporting, tracking and
monitoring of sexual assault activity will be provided as a result of the
Workgroup's recommendations.

William
Schoenhard, FACHE

Memorandum

Department of Veterans Affairs

Date: June 10, 2011

From: Deputy Under Secretary for
Health for Operations and Management (10N)

Subj: Actions Needed to Improve
Physical Security Requirements

To: Network Directors (10N 1-23)

Background. On June 7, 2011, the
Government Accountability Office (GAO) issued its report: VA HEALTH CARE:
Actions Needed to Prevent Sexual Assaults and Other Safety Incidents, and
provided recommendations to the Department of Veterans Affairs to improve both
the reporting and monitoring of sexual assault incidents and the tools used to
identify risks and address vulnerabilities at VA facilities. A
multidisciplinary team, the Safety and Security from Sexual Victimization
Workgroup, has been established to address all of the recommendations in this
report and will provide an action plan by July 15, 2011.

The safety and security of all
individuals on our campuses is paramount. There are a few things that we can
undertake immediately without waiting for the workgroup's recommendations,
namely ensuring compliance with all existing safety and security policies and
procedures.

A systematic
environmental assessment must be undertaken now at all of our facilities to
eliminate environmental factors that may contribute to physical security
deficiencies. Per VA Handbook 0730/2, Security and Law Enforcement,
Directors of VA field facilities are responsible for the physical security
protection of persons on VA property and this memorandum provides additional
information and standards to further enhance safety and security precautions.

Policy for Testing Alarm Systems. VHA recognizes and
acknowledges the importance of regularly testing physical security systems.
Therefore, it is expected that all VA facilities should have established
policies regarding the use and testing of alarm systems to include panic
alarms. These policies should be specific to the unique circumstances at each
VAMC, but designed to comply with the stringent standards of The Joint
Commission (TJC). If a VAMC does not have a policy, the VAMC must establish
and implement a policy NLT 30 days after date of this memo.

Testing and
Preventative Maintenance. It is imperative that testing and preventative
maintenance of these systems be conducted regularly in accordance with VAMC
policies and manufacturers' requirements for each system. VA Handbook 0730/2sets forth detailed
physical requirements for alarms for specific functions at each VAMC based on the risks inherent in
a given area (e.g., pharmacy
would be a higher risk area than environmental services). The handbook
further specifies that the exact location of panic/duress alarm switches are to
be determined by physical security surveys of the protected area/s. Due to the
variability in types of alarm systems based on location and services offered,
each
Service in each VAMC must have established and must enforce standard operating
procedures (SOP) for regular alarm testing based on industry and manufacturer
standards. At a minimum testing will be conducted semi-annually with a systematic process
for the documentation of all alarm system testing.

Monitoring of Alarm Systems. Additionally, each VAMC must
have a 24/7plan and implementation strategy for:
VA Police command and control centers to monitor alarms and surveillance
cameras; and Response capabilities for all alarm systems.

Summary of
Requirements to Ensure Physical Security. To summarize, every Network Director
is responsible for ensuring that each VAMC has a physical security assessment
plan that includes:

Policies for use and testing of
alarm systems, including panic alarms;

Regular testing of these alarms
systems, including panic alarms;

Documentation of testing:
o A plan and
implementation strategy for VA Police command and control centers to monitor
alarms and surveillance cameras; and

A plan and implementation strategy for 24f7 response
capabilities and preventative maintenance.

Every Network
Directors must document and submit the attached attestation that each VAMC has
been reviewed for compliance, the VISN is compliant with all physical security
policies, and an action plan and timeline have been developed to implement a
physical assessment plan to ensure adequate security controls. Network
Directors will send the completed attestations with supporting documentation to Deesha Brown
no later than 2pm (EST) on June 24, 2011. If you have any
questions, please contact Deesha Brown, Executive Assistant to the DUSHOM, at
Deesha.Brown@va.gov or (202) 461-6945 or Michael Moreland, Network Director VISN
4, in his capacity as the Chair of the Environment of Care subgroup of the
Safety and Security from Sexual Victimization Workgroup, at MichaeI.Moreland@va.gov or (412) 822-3316.

Additional
guidance may be forthcoming as a result of the analysis of the VISN's
environmental assessments and will be provided as a result of the Workgroup's
recommendations.